Doctors have called for an urgent review of transfusion policies after a UK-wide study of over 200 hospitals found that patients admitted with acute upper gastrointestinal bleeding (AUGIB) are more than twice as likely to suffer further bleeding if they receive a red blood cell transfusion within 12 hours.
The study, in the July issue of Alimentary Pharmacology and Therapeutics, also found that death rates were more than a quarter higher in patients who had received transfusions within that timescale.
"AUGIB accounts for 14 per cent of red blood cell units transfused in the UK" says Professor Richard Logan from the University of Nottingham Medical School. "While red blood cell transfusions may save the lives of people who are experiencing considerable blood loss, the benefits are less evident when the bleeding is not as severe."
All UK National Health Service hospitals accepting acute admissions in the UK were invited to participate and 221 (82 per cent) agreed. Each hospital identified a clinical lead, who coordinated a team of case-identifiers and data-collectors.
Complete data was submitted to a secure website on 4,441 patients admitted during the two-month study period. For the purposes of the study, re-bleeding was identified as any bleeding occurring after first endoscopy.
The figures were adjusted using the initial haemoglobin (red blood) levels and the Rockall score - a widely used and well-established risk scoring tool – to take account of underlying differences between the transfused and non transfused patients. This enabled the researchers to isolate the effect that early transfusion, on its own, had on the patients.
Key findings included:
"While our findings may be surprising, it should be pointed out that transfusions to replace red blood cells can sometimes result in serious adverse effects" says Professor Logan, who carried out the research with transfusion and gastroenterology experts from Edinburgh and Oxford.
"These can include increased risk of post-operative infection, acute respiratory distress syndrome, multi-organ failure and death.
"No clear mechanisms have been established yet to explain the increased risk of re-bleeding associated with blood transfusion found in this study.
"What is clear, however, is that a randomised comparison of restrictive and liberal transfusion policies in AUGIB is urgently required."
Notes to editors:
Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Hearnshaw et al. Alimentary Pharmacology & Therapeutics. 32, pp215-224. (July 2010). DOI: 10.1111/j.1365-2036.2010.04348.x
Alimentary Pharmacology & Therapeutics is an international journal of Gastroenterology and Hepatology. The journal accepts original papers and systematic reviews concerned with clinical Gastroenterology, Hepatology and Endoscopy. AP&T is particularly interested in therapies and diagnostics, including all aspects of translation from bench to bedside: identification of novel therapeutic targets, epidemiology, clinical trials, drug safety and meta-analyses. www.apandt.org
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