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Paper Chase 2: Upper GI Bleeds

Sanjay Arora, MD and Mike Menchine, MD
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EM:RAP 2013 December - Summary 1 MB - PDF

Do you work in an ED wildly transfusing precious blood to any and all upper GI bleeders? Well, stop it. And now there's a paper that explains why.

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Gregory O. -

One thing that I haven't heard discussed about this article is that everyone got 1 unit of blood right off the bat. "In both groups, 1 unit of red cells was transfused initially; the hemoglobin level was assessed after the transfusion, and an additional unit was transfused if the hemoglobin level was below the threshold value". Many people have taken this study as meaning you should check some labs and only tranfuse if the Hgb < 7.0. That might be a reasonable practice, but that was not what was done in this trial.

Stephen G. -

Agree with Gregory. If we're going to use their Hgb cutoff for transfusion, then should we be giving one unit of packed cells to every patient with UGIB? This is a very important issue with this paper.

Skye C., Dr -

Although I agree they are not clear in the methods, I think it is a misinterpretation to assume that everyone got transfused prior to knowing their hemoglobin. If everyone got a unit right way, every patient in the study would have been transfused. They say that only 49% of the restrictive group and 86% of the liberal group get transfused.

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Episode 147 Full episode audio for MD edition 275:31 min - 130 MB - M4AResumen del EM:RAP Diciembre 2013 Español 83:52 min - 115 MB - MP3EM:RAP 2013 December Bonus MP3 47 MB - ZIPEM:RAP 2013 December MP3 272 MB - ZIPEM:RAP 2013 December - Summary 1 MB - PDFEM:RAP December 2013 Board Review Questions 594 KB - PDFEM:RAP December 2013 Board Review Answers 456 KB - PDF

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