3.2 Effect of red blood cell transfusion on outcomes

3.2.5 Acute upper gastrointestinal blood loss

Evidence Statements for Acute upper gastrointestinal blood loss
Evidence Statements –
acute upper gastrointestinal blood loss
Evidence Consistency Clinical impact Generalisability Applicability
ES2.10 In patients with acute upper gastrointestinal blood loss, the effect of a restrictive versus liberal RBC transfusion strategy on mortality is uncertain. X NA NA X
ES2.11 In patients with acute upper gastrointestinal blood loss, the effect of RBC transfusion on mortality is uncertain. NA NA

ES, evidence statement; RBC, red blood cell

=A; =C; X=D, NA,not applicable (see Table 2.1)

Practice Points – acute upper gastrointestinal blood loss
PP10 In well-compensated patients with acute upper gastrointestinal blood loss that is non-critical, there is no evidence to favour a liberal transfusion policy. Therefore, a more restrictive approach may be appropriate. There are no data to support a specific Hb treatment target in these patients.
PP11 For critically bleeding patients, refer to Patient Blood Management Guidelines: Module 1 – Critical Bleeding/Massive Transfusion (2011).4

Hb, haemoglobin; PP, practice point

A poor-quality RCT (Level II)91 assessed the effect of RBC transfusion on mortality. The study was underpowered to detect differences in the treatment arms; however, the transfused group experienced significantly higher rates of rebleeding. A good-quality prospective cohort study (Level III-2)92 assessed the risk of mortality relating to early RBC transfusion in patients with acute upper gastrointestinal haemorrhage. These results demonstrated no significant association between RBC transfusion and mortality.

In the absence of strong evidence, guidance relating to transfusion policies in this patient group can be found in practice points made by the CRG, and extrapolated from experience in other patient populations.