Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion.
<h4>Background</h4>The national blood shortage and growing patient population who decline blood transfusions have created the need for bloodless medicine initiatives. This case series describes the management of gastrointestinal bleed patients who declined allogeneic blood transfusion. U...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0290351 |
| _version_ | 1797693926308577280 |
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| author | Jessica O Asiedu Ananda J Thomas Nicolas C Cruz Ryan Nicholson Linda M S Resar Mouen Khashab Steven M Frank |
| author_facet | Jessica O Asiedu Ananda J Thomas Nicolas C Cruz Ryan Nicholson Linda M S Resar Mouen Khashab Steven M Frank |
| author_sort | Jessica O Asiedu |
| collection | DOAJ |
| description | <h4>Background</h4>The national blood shortage and growing patient population who decline blood transfusions have created the need for bloodless medicine initiatives. This case series describes the management of gastrointestinal bleed patients who declined allogeneic blood transfusion. Understanding the effectiveness of bloodless techniques may improve treatment for future patients while avoiding the risks and cost associated with transfusion.<h4>Study design and methods</h4>A retrospective chart review identified 30 inpatient encounters admitted between 2016 to 2022 for gastrointestinal hemorrhage who declined transfusion due to religious or personal reasons. Clinical characteristics and patient blood management methods utilized during hospitalization were analyzed. Hemoglobin concentrations and clinical outcomes are reported.<h4>Results</h4>The most common therapy was intravenous iron (n = 25, 83.3%), followed by erythropoietin (n = 18, 60.0%). Endoscopy was the most common procedure performed (n = 23, 76.7%), and surgical intervention was less common (n = 4, 13.3%). Pre-procedure hemoglobin was <6 g/dL in 7 patients, and <5 g/dL in 4 patients. The median nadir hemoglobin was 5.6 (IQR 4.5, 7.0) g/dL, which increased post-treatment to 7.3 (IQR 6.2, 8.4) g/dL upon discharge. One patient (3.3%) with a nadir Hb of 3.7 g/dL died during hospitalization from sepsis. Nine other patients with nadir Hb <5 g/dL survived hospitalization.<h4>Conclusions</h4>Gastrointestinal bleed patients can be successfully managed with optimal bloodless medicine techniques. Even patients with a nadir Hb <5-6 g/dL can be stabilized with aggressive anemia treatment and may safely undergo anesthesia and endoscopy or surgery for diagnostic or therapeutic purposes. Methods used for treating bloodless medicine patients may be used to improve clinical care for all patients. |
| first_indexed | 2024-03-12T02:49:38Z |
| format | Article |
| id | doaj.art-d3ec1bb63ba74f6b9523b015595f66db |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-12T02:49:38Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-d3ec1bb63ba74f6b9523b015595f66db2023-09-04T05:31:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01188e029035110.1371/journal.pone.0290351Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion.Jessica O AsieduAnanda J ThomasNicolas C CruzRyan NicholsonLinda M S ResarMouen KhashabSteven M Frank<h4>Background</h4>The national blood shortage and growing patient population who decline blood transfusions have created the need for bloodless medicine initiatives. This case series describes the management of gastrointestinal bleed patients who declined allogeneic blood transfusion. Understanding the effectiveness of bloodless techniques may improve treatment for future patients while avoiding the risks and cost associated with transfusion.<h4>Study design and methods</h4>A retrospective chart review identified 30 inpatient encounters admitted between 2016 to 2022 for gastrointestinal hemorrhage who declined transfusion due to religious or personal reasons. Clinical characteristics and patient blood management methods utilized during hospitalization were analyzed. Hemoglobin concentrations and clinical outcomes are reported.<h4>Results</h4>The most common therapy was intravenous iron (n = 25, 83.3%), followed by erythropoietin (n = 18, 60.0%). Endoscopy was the most common procedure performed (n = 23, 76.7%), and surgical intervention was less common (n = 4, 13.3%). Pre-procedure hemoglobin was <6 g/dL in 7 patients, and <5 g/dL in 4 patients. The median nadir hemoglobin was 5.6 (IQR 4.5, 7.0) g/dL, which increased post-treatment to 7.3 (IQR 6.2, 8.4) g/dL upon discharge. One patient (3.3%) with a nadir Hb of 3.7 g/dL died during hospitalization from sepsis. Nine other patients with nadir Hb <5 g/dL survived hospitalization.<h4>Conclusions</h4>Gastrointestinal bleed patients can be successfully managed with optimal bloodless medicine techniques. Even patients with a nadir Hb <5-6 g/dL can be stabilized with aggressive anemia treatment and may safely undergo anesthesia and endoscopy or surgery for diagnostic or therapeutic purposes. Methods used for treating bloodless medicine patients may be used to improve clinical care for all patients.https://doi.org/10.1371/journal.pone.0290351 |
| spellingShingle | Jessica O Asiedu Ananda J Thomas Nicolas C Cruz Ryan Nicholson Linda M S Resar Mouen Khashab Steven M Frank Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion. PLoS ONE |
| title | Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion. |
| title_full | Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion. |
| title_fullStr | Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion. |
| title_full_unstemmed | Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion. |
| title_short | Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion. |
| title_sort | management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion |
| url | https://doi.org/10.1371/journal.pone.0290351 |
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