On 2/19, we’ll discuss the recent NEJM publication on transfusion strategies in upper GI bleeds. Their results may surprise you. Can they be extrapolated to other bleeders?
Read, enjoy, and post.
http://www.nejm.org/doi/full/10.1056/nejmoa1211801
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
The following two tabs change content below.
jfreedman
Latest posts by jfreedman (see all)
- Less is More - April 13, 2015
- Don’t just do something, stand there. - January 19, 2015
- All pressure is created equal - September 15, 2014
- The “Soft” Code - June 23, 2014
- 6/25 Adult Journal Club - June 16, 2014
I remember being a resident in the MICU, transfusing patients (esp if they had a cardiac history) to a target hgb of 10, no matter if they GIB or not. But, I haven’t practice that as Attending. I don’t get nervous about a drop until lower than 7, even if GIB. I think we should go more by trend in H/H and symptoms than playing the numbers game.
Sorry for the late reply. In general, I think this is yet another example of doctors doing too much and causing harm. Reminds me of a rule from House of God – “the ideal delivery of medical care is to do as much nothing as possible.” I like Dr. Smith’s recommendation for trends, and will add in including patient’s symptoms in deciding whether or not to transfuse.
Also, there was a great sub-group analysis of this paper found here
http://www.ncbi.nlm.nih.gov/pubmed/11246298 titled “transfusion threshold safe in critically ill patients with cardiovascular diseases?” The gist is: they divided patients with known cardiac dx into hgb goal of 10 vs hgb goal of 7. Results: less blood given to restrictive strategy, equal mortality and length of ICU stay, less incidences of end organ damage.
Recently on my medicine rotation, we would transfuse patients whose Hb fell below 7, to a goal of 8. Otherwise, we would use serial Hbs. I also remember that GI would not scope anyone below an Hb of 8 (for one pt, they would not scope unless the Hb was 10). I think this study can be used in the argument against transfusion to a goal of 10. But obviously, if a pt needs to be scoped, given the risk and complications of scoping, a Hb of 8 would seem acceptable. The question I do have, is how do we apply this information to pt with chronically low Hb, such as sicklers or pt with anemia of chronic disease?