• Zaki Hamarneh, Kathryn Robinson, Jane Andrews, Russell Hunt, and Robert Fraser.
• Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia.
• Intern Med J. 2020 May 1; 50 (5): 582-589.

BackgroundUpper gastrointestinal bleeding (UGIB) is a common cause of hospital admission and red cell transfusion is frequently required. A large single-centre randomised study from 2013 showed that a restrictive transfusion strategy in UGIB management was associated with better outcomes compared to a liberal strategy. Subsequently multiple international guidelines favour a restrictive transfusion strategy. However, given the multiple exclusion criteria in the study, generalisation to everyday practice was unclear.AimsTo assess applicability of the data to a non-trial UGIB population and determine how often restrictive thresholds are used in clinical practice.MethodsA retrospective case note review of patients with an UGIB admission during 2014 in three tertiary hospitals was undertaken. Information collected included demographics, comorbidities and factors associated with transfusion, such as apparent haemoglobin triggers and units transfused. The proportion of patients who would have met inclusion criteria of the study was calculated.ResultsOf 89 UGIB admissions reviewed, up to 70% would be suitable for a restrictive approach. Use of this approach was evident in only 26% of transfusion episodes in patients meeting inclusion criteria. However, assessment was, limited by rapidly changing clinical status and potential for overestimation of true haemoglobin level with fluid resuscitation and equilibration.ConclusionA restrictive transfusion strategy may be suitable for many patients presenting with UGIB; however, important exclusions were not uncommon. Opportunities for increased uptake of restrictive thresholds were identified. Ongoing improvement initiatives should address the risks of both over and under-transfusion.© 2019 Royal Australasian College of Physicians.

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