Paper Chase 2: Upper GI Bleeds

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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. -

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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