Outcomes of Acute Gastrointestinal Bleeding Without Blood Transfusion: A Specialized Unit Experience

Abstract

Outcomes of Acute Gastrointestinal Bleeding Without Blood Transfusion: A Specialized Unit Experience Irfan Nawaz, Rabi Kundu, Amit Thaker, George Ahtaridis Purpose: Blood transfusion is a standard practice in the management of acute gastrointestinal bleeding (GIB). Our hospital is a specialized unit to manage patients refusing blood transfusions due to religious or personal reasons. There is no published outcome data regarding the management of acute GIB without blood transfusion. The aim of this study was to evaluate the outcomes of this patient population. Methods: Retrospective case control study designed for acute GIB patients treated in our tertiary center. Study period was January 2002 to October 2005. Bloodless care patients (case) were compared with standard care patients (control) that required blood transfusion. Inclusion criteria were; Hemoglobin drop 2 gm/dl and/or signs of hypovolemia. Patient demographics, presenting complaints, risk factors, time to endoscopy, duration of ICU and hospital stay were evaluated. Dose of erythropoietin,rebleeding rates and mortalities were also reviewed. Results: 39 patients satisfied the inclusion criteria in study group and 115 patients in the control group. There was no significant difference in patient demographics, presentation and risk factors. (Table 1) Mean time to endoscopy in study group was 24.24 hours compared to control 44.12 hours. Mean ICU stay was 2 days in study group and 1.48 days in control (p Z 0.02).There was no significant difference in duration of hospitalization (p Z 0.33) and rebleebing rates (p Z 0.88) between two groups. There was 1 death in bloodless care group and 3 in standard care group (p Z 0.57) (Table 2). All patients in study group received iron, while 70% (27/39) received erythropoietin (mean dose 470 U/kg) Conclusion: In our study,the outcomes of acute GI bleeding in bloodless care group were comparable to standard care group with early endoscopy, closer ICU monitoring and support with IV iron and high dose erythropoietin.