GI Bleeding: The Evidence Behind When to Transfuse?

When patients present to the Emergency Department with acute upper GI bleeding, the natural inclination is to quickly pull the transfusion trigger. However, a 2013 study gives us pause... 

Villaneuva et al. "Transfusion Strategies for Acute Upper Gastrointestinal Bleeding." New England Journal of Medicine. 368:11-21.

Study Design: Randomized control trial that compared a restrictive transfusion strategy (Hemoglobin: 7 g/dL) to a liberal transfusion strategy (Hemoglobin: 9 g/dL).

Results: A transfusion trigger at a hemoglobin of 7g/dL may be safe in non-exsanguinating, GI bleeders, as the results showed better outcomes for those receiving the restrictive strategy.

Existing literature has demonstrated that a higher threshold for transfusion is beneficial in many populations (i.e., sepsis). This article adds to that literature when a patient with severe GI bleeding is not massively exsanguinating.