Featured Research

from universities, journals, and other organizations

Early transfusion increases acute upper GI re-bleeding risk, UK hospital study suggests

Date:
July 7, 2010
Source:
Wiley - Blackwell
Summary:
Doctors have called for an urgent review of transfusion policies after a UK-wide study of 221 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 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.

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.

Related Articles


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:

  • 44 per cent of the patients with AUGIB were transfused with red blood cells within 12 hours of admission.
  • Adjusted odds ratio figures showed that patients who were transfused in the first 12 hours faced a 126 per cent greater chance of re-bleeding than patients who had not been transfused. New admissions faced a higher risk of re-bleeding than people who were already in-patients.
  • Patients with haemoglobin levels lower than 8g/dL were more likely to experience re-bleeding if they received a transfusion in the first 12 hours than those who did not receive a transfusion (23 per cent compared with 15 per cent).
  • The difference in re-bleeding rates was much greater between patients with haemoglobin rates that exceeded 8g/dL -- 24 per cent of patients transfused in the first 12 hours experienced re-bleeds, compared with 6.7 per cent of patients who did not receive a transfusion.
  • The unadjusted death rate for all patients was 7.8 per cent and was significantly higher in inpatients (20 per cent) than new admissions (5.4 per cent). The adjusted death rate showed that patients who received early transfusions were 28 per cent more likely to die than those who had not been transfused.
  • Death rates were 13 per cent for all patients with an initial haemoglobin level of 8g/dL or less, regardless of whether they had received a transfusion. However in patients over 8g/dL, the mortality rates were 11 per cent in transfused patients and 4.3 per cent in patients who had not been transfused.
  • Early transfusions were more likely to be given to patients who showed signs of haemodynamic instability, had a lower initial haemoglobin level and, when endoscoped, were found to have peptic ulcers, dilated veins in the oesophagus or major signs of recent bleeding.

"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."


Story Source:

The above story is based on materials provided by Wiley - Blackwell. Note: Materials may be edited for content and length.


Journal Reference:

  1. S. A. Hearnshaw, R. F. A. Logan, K. R. Palmer, T. R. Card, S. P. L. Travis, M. F. Murphy. Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics, 2010; 32 (2): 215 DOI: 10.1111/j.1365-2036.2010.04348.x

Cite This Page:

Wiley - Blackwell. "Early transfusion increases acute upper GI re-bleeding risk, UK hospital study suggests." ScienceDaily. ScienceDaily, 7 July 2010. <www.sciencedaily.com/releases/2010/07/100707065212.htm>.
Wiley - Blackwell. (2010, July 7). Early transfusion increases acute upper GI re-bleeding risk, UK hospital study suggests. ScienceDaily. Retrieved October 24, 2014 from www.sciencedaily.com/releases/2010/07/100707065212.htm
Wiley - Blackwell. "Early transfusion increases acute upper GI re-bleeding risk, UK hospital study suggests." ScienceDaily. www.sciencedaily.com/releases/2010/07/100707065212.htm (accessed October 24, 2014).

Share This



More Health & Medicine News

Friday, October 24, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com
WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Doctor in NYC Quarantined With Ebola

Doctor in NYC Quarantined With Ebola

AP (Oct. 24, 2014) An emergency room doctor who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus. He's quarantined in a hospital. (Oct. 24) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins