HONOLULU — Management of acute GI bleeding in patients who for religious or personal reasons refuse blood transfusion is a challenge but can be done, with outcomes equal to those in conventionally treated patients, Irfan Nawaz, M.D., said at the annual meeting of the American College of Gastroenterology.
The keys are early endoscopy, close monitoring in the intensive care unit, and support using high-dose erythropoietin and iron, added Dr. Nawaz of the Graduate Hospital, Philadelphia.
The Graduate Hospital has established a program with protocols for bloodless management in patients with acute GI bleeding who refuse blood transfusion. Dr. Nawaz presented a retrospective study comparing outcomes in 105 consecutive patients who presented with acute GI bleeding. Thirty-two refused blood transfusions, and the remaining 73 conventionally managed patients served as controls.
The risk factors for acute GI bleeding were similar, with roughly half of patients in each group having been on NSAIDs or antiplatelet agents. The mean hemoglobin at presentation was 9.3 g/dL in the bloodless management group and 9.8 g/dL in controls.
Time to endoscopy averaged 22 hours in the bloodless management group, compared with 46 hours in conventionally managed controls.
Although total length of hospital stay was similar in the two groups, averaging about 6.8 days, transfusion refusers spent an average of 2 days in the ICU, while controls spent 1.1 day.
All 32 patients in the bloodless management group received iron supplementation, and 25 also received erythropoietin at a mean dose of 465 U/kg, Dr. Nawaz said. One death occurred in each study arm.