Introduction Upper GI bleeding (UGIB) is the most common indication for transfusion in England, comprising 14% of all transfusions.1 Evidence has demonstrated a restrictive as opposed to liberal transfusion policy improves clinical outcome.2 In addition to the known clinical benefits, our aim was to asssess whether a more restrictive transfusion policy would save significant resources.
Methods We conducted a prospective audit of consecutive patients presenting to the Royal Devon and Exeter hospital with UGIB during a 9 week period from 7.12.12. The case notes and laboratory data were reviewed. Unstable patients, those with evidence of massive UGIB and those not receiving blood transfusion were excluded. Liberal transfusion was defined as haemoglobin >80 g/L pre-transfusion or a post transfusion haemoglobin >90 g/L. We calculated the number of additional units transfused beyond these parameters.
Results 79 patients presented with an UGIB. 42 patients received a total of 170 units of red blood cells. 7 patients were transfused 1 unit, 33 patients were transfused 2 units, and 28 patients received ≥3 units. 30/42 were transfused in a liberal manner, resulting in the potentially unnecessary use of 68 additional units at a cost of £8,302.
Conclusion A significant number of patients received transfusions according to our definition of a liberal transfusion strategy, usually receiving several units at a time. A restrictive transfusion policy has been proven to be safe and would also result in significant cost savings.
References 1 Wallis JP, Wells AW, Chapman CE. Changing indications for red cell transfusion from 2000 to 2004 in the North of England. Transfus Med. 2006;16:411–417.
2 Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368:11–21.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.