Hospital study suggests that early transfusion increases acute upper GI re-bleeding risk

Jul 07, 2010

Doctors have called for an urgent review of transfusion policies after a UK-wide study of over 200 hospitals found that patients admitted with acute upper gastrointestinal bleeding (AUGIB) are more than twice as likely to suffer further bleeding if they receive a red blood cell transfusion within 12 hours.

The study, in the July issue of Alimentary Pharmacology and Therapeutics, also found that death rates were more than a quarter higher in patients who had received transfusions within that timescale.

"AUGIB accounts for 14 per cent of red blood cell units transfused in the UK" says Professor Richard Logan from the University of Nottingham Medical School. "While red blood cell transfusions may save the lives of people who are experiencing considerable , the benefits are less evident when the bleeding is not as severe."

All UK National Health Service hospitals accepting acute admissions in the UK were invited to participate and 221 (82 per cent) agreed. Each hospital identified a clinical lead, who coordinated a team of case-identifiers and data-collectors.

Complete data was submitted to a secure website on 4,441 patients admitted during the two-month study period. For the purposes of the study, re-bleeding was identified as any bleeding occurring after first .

The figures were adjusted using the initial haemoglobin (red blood) levels and the Rockall score - a widely used and well-established risk scoring tool - to take account of underlying differences between the transfused and non transfused patients. This enabled the researchers to isolate the effect that early transfusion, on its own, had on the patients.

Key findings included:

  • 44 per cent of the patients with AUGIB were transfused with within 12 hours of admission.
  • Adjusted odds ratio figures showed that patients who were transfused in the first 12 hours faced a 126 per cent greater chance of re-bleeding than patients who had not been transfused. New admissions faced a higher risk of re-bleeding than people who were already in-patients.
  • Patients with haemoglobin levels lower than 8g/dL were more likely to experience re-bleeding if they received a transfusion in the first 12 hours than those who did not receive a transfusion (23 per cent compared with 15 per cent).
  • The difference in re-bleeding rates was much greater between patients with haemoglobin rates that exceeded 8g/dL - 24 per cent of patients transfused in the first 12 hours experienced re-bleeds, compared with 6.7 per cent of patients who did not receive a transfusion.
  • The unadjusted death rate for all patients was 7.8 per cent and was significantly higher in inpatients (20 per cent) than new admissions (5.4 per cent). The adjusted death rate showed that patients who received early transfusions were 28 per cent more likely to die than those who had not been transfused.
  • Death rates were 13 per cent for all patients with an initial haemoglobin level of 8g/dL or less, regardless of whether they had received a transfusion. However in patients over 8g/dL, the mortality rates were 11 per cent in transfused patients and 4.3 per cent in patients who had not been transfused.
  • Early transfusions were more likely to be given to patients who showed signs of haemodynamic instability, had a lower initial haemoglobin level and, when endoscoped, were found to have peptic ulcers, dilated veins in the oesophagus or major signs of recent bleeding.
"While our findings may be surprising, it should be pointed out that transfusions to replace red blood cells can sometimes result in serious adverse effects" says Professor Logan, who carried out the research with transfusion and gastroenterology experts from Edinburgh and Oxford.

"These can include increased risk of post-operative infection, acute respiratory distress syndrome, multi-organ failure and death.

"No clear mechanisms have been established yet to explain the increased risk of re-bleeding associated with blood transfusion found in this study.

"What is clear, however, is that a randomised comparison of restrictive and liberal policies in AUGIB is urgently required."

Explore further: Ebola reveals shortcomings of African solidarity

More information: Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Hearnshaw et al. Alimentary Pharmacology & Therapeutics. 32, pp215-224. (July 2010). DOI: 10.1111/j.1365-2036.2010.04348.x

add to favorites email to friend print save as pdf

Related Stories

Old red blood cells may double mortality in trauma patients

Sep 22, 2009

Severe trauma patients requiring a major transfusion are twice as likely to die if they receive red blood cells stored for a month or longer, according to research published in BioMed Central's open access journal Critical Ca ...

Blood transfusions associated with infection

Jul 31, 2009

A study of almost 25,000 coronary artery bypass graft (CABG) patients has shown that receiving blood from another person is associated with a two-fold increase in post-operative infection rates. The research, published in ...

'Old blood' linked to infection

Oct 28, 2008

Blood stored for 29 days or more, nearly 2 weeks less than the current standard for blood storage, is associated with a higher infection rate in patients who received transfusions with the blood. In a new study presented ...

Recommended for you

Ebola reveals shortcomings of African solidarity

16 hours ago

As Africa's leaders meet in Ethiopia to discuss the Ebola crisis, expectations of firm action will be tempered by criticism over the continent's poor record in the early stages of the epidemic.

Second bird flu case confirmed in Canada

Jan 30, 2015

The husband of a Canadian who was diagnosed earlier this week with bird flu after returning from a trip to China has also tested positive for the virus, health officials said Friday.

What exactly is coronavirus?

Jan 30, 2015

The conflicts in Syria and Iraq are straining public health systems and public health efforts meant to prevent and detect the spread of infectious diseases. This is generating a "perfect storm" of conditions for outbreaks. Among the infections raising concern is Middle East Respiratory Syndrome, caused by a type of coronavirus, which emerged in 2012. ...

Scientists find Ebola virus is mutating

Jan 30, 2015

(Medical Xpress)—Researchers working at Institut Pasteur in France have found that the Ebola virus is mutating "a lot" causing concern in the African countries where the virus has killed over eight thous ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.