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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, ducji@reg2.health.nb.ca

Abstract

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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

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