David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) reviewing Lee JM et al. Endosc Int Open 2016 Jul 21.

Results support the current conservative strategy for blood transfusion in these patients.

Outcomes of nonvariceal upper gastrointestinal bleeding (UGIB) are adversely affected by vigorous blood transfusion (NEJM JW Gastroenterol Jun 2016/ and Transfusion 2015 Dec 31; [e-pub]). Conversely, the potential for adverse outcomes in patients discharged with low hemoglobin levels after hospitalization for UGIB, though unclear, is also a concern.

Investigators in Korea retrospectively identified 102 patients who underwent therapeutic endoscopy for UGIB and compared outcomes at 7 and 45 days after discharge between 50 patients with a low discharge hemoglobin level (8 ≤ Hgb < 10 g/dL) and 52 with a high level (Hgb ≥10 g/dL). Rockall and Glasgow-Blatchford scores were similar in the two groups.

The mean discharge hemoglobin levels in the low and high hemoglobin groups, respectively, were 8.8 ± 0.7 g/dL versus 10.9 ± 0.9 g/dL (P<0.001) and at 7 days after discharge were 10.4 ± 1.0 g/dL versus 11.4 ± 1.1 g/dL (P< 0.001). At 45 days postdischarge, hemoglobin levels were similar between groups. Dizziness was more common in the low hemoglobin group, but other symptoms and risk for rebleeding were similar.

CITATION(S):

Lee JM et al. Discharge hemoglobin and outcome in patients with acute nonvariceal upper gastrointestinal bleeding. Endosc Int Open 2016 Jul 21; [e-pub]. 

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