Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T13:20:19.225Z Has data issue: false hasContentIssue false
  • English
  • Français

Recurrent bleeding in acute upper gastrointestinal hemorrhage: transfusion confusion

Published online by Cambridge University Press:  21 May 2015

Jeffery L. Ginn  and
James Ducharme
Jeffery L. Ginn*
Affiliation:
Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Nfld.
James Ducharme
Affiliation:
Atlantic Health Sciences Corporation, Saint John Regional Hospital, Saint John, NB
*
Department of Emergency Medicine, Saint John Regional Hospital, PO Box 2100, Saint John NB E2L 4L2; fax 506 648-6055, [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Acute upper gastrointestinal (UGI) hemorrhage is a common, often serious condition encountered in the emergency department (ED). Previous research has suggested that transfusion of blood products may interfere with the hypercoagulable state induced by significant blood loss. Our objective was to determine whether the frequency of rebleeding is higher in patients with UGI bleeding who have received early blood transfusion.

Methods:

The study was a retrospective chart review of patients admitted to hospital through the ED with a diagnosis of UGI hemorrhage. Inclusion criteria limited analysis to patients presenting with hematemesis, melena, or bloody nasogastric aspirate, in whom a UGI lesion was confirmed endoscopically during admission.

Results:

A total of 214 charts were analyzed. Baseline demographic characteristics were similar in transfused and non-transfused patients. Presenting hemoglobin level was lower in the transfused group (86.5 v. 119.2 g/L, p < 0.001). Recurrent bleeding occurred in 99 (46%) patients and was more common in transfused patients (67 [66%] v. 33 [29%], p < 0.001). Logistic regression analysis revealed that transfusion and presenting hemoglobin level were the only variables with a statistically significant independent association with bleeding recurrence (p < 0.001 and p < 0.05 respectively).

Conclusions:

Our results support previous research suggesting that transfused UGI bleed patients have a higher rate of rebleeding. However, because of the retrospective design, causality cannot be inferred.

Keywords

upper gastrointestinal hemorrhagetransfusionsblood products (complications)
Type
EM Advances • Progrès de la MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 3 , July 2001 , pp. 193 - 198
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Peura, DA, Lanza, FL, Gostout, CJ, Foutch, PG.The American College of Gastroenterology Bleeding Registry: preliminary findings. Am J Gastroenterol 1997;92(6):924–8.Google Scholar
2.Corley, DA, Stefan, AM, Wolf, M, Cook, EF, Lee, TH.Early indicators of prognosis in upper gastrointestinal hemorrhage. Am J Gastroenterol 1998;93(3):336–40.Google Scholar
3.Mueller, X, Rothenbuehler, JM, Amery, A, Harder, F.Factors predisposing to further hemorrhage and mortality after peptic ulcer bleeding. J Am Coll Surg 1994;179:457–61.Google Scholar
4.Zimmerman, J, Siguencia, J, Tsvang, E, Beeri, R, Arnon, R.Predictors of mortality in patients admitted to hospital for acute gastrointestinal hemorrhage. Scand J Gastroenterol 1995;30:327–31.CrossRefGoogle Scholar
5.Rockall, TA, Logan, RFA, Devlin, HB, Northfield, TC.Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. BMJ 1995;311:222–6.CrossRefGoogle ScholarPubMed
6.Rockall, TA, Logan, RFA, Devlin, HB, Northfield, TC.Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316–21.Google Scholar
7.Macleod, IA, Mills, PR.Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg 1982;69:256–8.CrossRefGoogle ScholarPubMed
8.Blair, SD, Janvrin, SB, McCollum, CN, Greenhalgh, RM.Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986;73:783–5.Google Scholar
9.Henriksson, AE, Svensson, JO.Upper gastrointestinal bleeding: with special reference to blood transfusion. Eur J Surg 1991;157:193–6.Google Scholar
10.Henriksson, AE, Bergqvist, D, Ljungberg, J, Hedner, U.Influence of haemorrhage and blood transfusion on haemostasis: an experimental study in rabbits. Vox Sang 1995;68:100–4.Google ScholarPubMed
11.Henriksson, AE, Nilsson, TK, Svensson, JO.Time course of clotting and fibrinolytic markers in acute upper gastrointestinal bleeding: relation to diagnosis and blood transfusion treatment. Blood Coagul Fibrinolysis 1993;4:877–80.Google Scholar
12.Hsu, PI, Lin, XZ, Chan, SH, Lin, CY, Chang, TT, Shin, JS, et al. Bleeding peptic ulcer: risk factors for rebleeding and sequential changes in endoscopic findings. Gut 1994;35:746–9.Google Scholar