OUTCOMES OF ACUTE GASTROINTESTINAL HEMORRHAGE IN BLOODLESS CARE POPULATION-A SINGLE CENTER EXPERIENCE

Abstract

Purpose: Acute Gastrointestinal Hemorrhage in bloodless care is a challenge to manage. Our hospital is an established center to manage patients who refuse blood transfusion for religious or other beliefs. No published outcomes data of acute gastrointestinal hemorrhage in this population is available. Methods: Retrospective chart review of acute gastrointestinal hemorrhage from Jan2002 and Dec2003. Study population was defined as admissions with acute GI hemorrhage in bloodless care patients who were compared with controls who received standard care. Inclusion criteria were: hemoglobin drop more than 2gms or hypovolemic shock. Parameters reviewed include demographics, use of antiplatelet agents, NSAIDS, admission diagnoses and hemodynamic parameters at presentation, time to endoscopy and surgery, duration of ICU and hospital stay, iron and erythropoietin use. Rebleeding rate and mortality rate were also reviewed.Table 1: ResultsResults: 26 patients in the study group and 49 control patients satisfied inclusion criteria. There was no significant difference in patient demographics, initial presentation(hematemesis, melena, hematochezia), hematocrit, use of NSAIDS and antiplatelet agents. The mean time to endoscopy in the study group was 21 hours(1–72) as compared to controls 49hours(7–144)(p <0.01). The mean ICU stay for the study group was 2.4 days as compared to controls 1.2 days(p <0.05). There was no significant difference in the duration of hospital stay between the two groups. Mean 7.6 days(1–22) in the study group vs7.0 days(1–19) days in controls. 19%(5/26) had surgery in the study group as compared to 6%(3/49) in controls. 11%(3/26) rebled in the study group as compared to 10%(5/49) in controls. There was no significant difference in mortality. All patients in the study group were treated with Iron and 73%(19/26) received erythropoietin (mean dose 472U/kg). Conclusions: The outcomes of bloodless care patients were comparable to standard care group with early endoscopy, close monitoring in ICU and support with iron and high dose of erythropoietin.