S657 Hemoglobin Transfusion Threshold of 6 g/dL for Acute Gastrointestinal Bleeding in the Setting of Blood Shortage Due to COVID-19 Pandemic in a Tertiary Community Hospital

Abstract

Introduction: Gastrointestinal bleed (GIB) is a common emergency condition associated with high mortality and morbidity. Current international guidelines recommend a hemoglobin (Hgb) transfusion threshold of 7 g/dL in patients with GIB. There was an initial blood shortage due to COVID-19 pandemic which prompted the need to lower hemoglobin. Primary outcome: rate of death from any cause within the first 30 days. Secondary outcome: rate of 30-day readmission and in-hospital complications. Methods: Retrospective single-center, IRB approved cohort. All adults (≥ 18 years old) who were admitted for GIB requiring blood transfusion prior to COVID-19 (10/1/2019-12-31/2019) and during the blood shortage period (4/1/2019-6/30/2020) due to COVID-19. Results: A total of 20 patients were admitted for GIB whose Hgb transfusion threshold at 7 g/dL prior to COVID-19, as compared with 17 patients with Hgb transfusion threshold at 6 g/dL during COVID-19 blood shortage period. There was no statistical significance in all cause mortality within the first 30 days (P=0.61), or rate of readmission within 30 days (P=0.42) when comparing the examined time period prior to versus during the time period with blood shortage due to COVID-19 pandemic. Also, there was no statistical difference between the two time periods when comparing in-hospital complications as a result of acute GIB (sepsis (P=1), acute kidney injury (P=0.58), hypoxia (P=1), unstable angina (P=1), NSTEMI (P=0.72), STEMI (P=0.42)). Conclusion: The rate of all-cause mortality within 30 days, 30-days readmission, and in-hospital complications from acute GIB did not differ when the hemoglobin transfusion threshold was lowered to 6 g/dL as compared to international guideline recommendation of 7 g/dL. The study is limited by small sample size; however, it reflects the patient population from a community hospital. If another pandemic is to occur, there may be less concern when there is a need to lower the Hgb transfusion threshold in the setting of blood loss anemia. The study helps to raise stronger awareness for blood donation to avoid blood shortage in the setting of an emergency, a pandemic in our case.Table 1.: Comparison of Inpatient Outcomes of NVUGIB Patients.