What is the efficacy of transfusion-free management of lower gastrointestinal (GI) bleeding?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

The management of lower gastrointestinal bleeding (LGIB) can be challenging in patients who refuse transfusions of blood or blood products. However, transfusion-free management of GI bleeding is possible with an acceptable mortality rate. [75]

In a retrospective review of 96 patients with LGIB who did not accept transfusions of blood and blood products, 30 of 37 patients (81%) with hemoglobin levels below 6 g/dL, and 4 of 7 patients (57%) with hemoglobin levels lower than 3 g/dL survived. [75] The inclusion criteria were frank LGIB, presenting hemoglobin levels lower than 12 g/dL, or a decrease in hemoglobin of more than 1.5 g/dL. Forty-one patients had upper GI bleeding and the remaining 48 had LGIB. [75]

The mean hemoglobin level was 8.8 g/dL. [75] Surviving patients were treated with epoetin alfa (Procrit) once daily for 5 days, intravenous (IV) iron dextran infusion once daily for 10 days, IV folic acid daily, vitamin C twice daily, as well as intramuscular vitamin B12 injection once. These patients also received beta-blockers (to reduce the cardiac workload) and supplemental oxygen (100%) with intubation (to improve the oxygen delivery as much as possible without blood transfusions). The overall mortality was 10%. [75]


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