Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts
Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limit...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.903739/full |
| _version_ | 1797995344188932096 |
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| author | Miguel Montoro Miguel Montoro Miguel Montoro Miguel Montoro Mercedes Cucala Ángel Lanas Ángel Lanas Ángel Lanas Ángel Lanas Cándido Villanueva Cándido Villanueva Antonio José Hervás Javier Alcedo Javier Alcedo Javier P. Gisbert Javier P. Gisbert Javier P. Gisbert Ángeles P. Aisa Luis Bujanda Luis Bujanda Luis Bujanda Xavier Calvet Xavier Calvet Xavier Calvet Fermín Mearin Óscar Murcia Pilar Canelles Santiago García López Santiago García López Carlos Martín de Argila Montserrat Planella Montserrat Planella Manuel Quintana Manuel Quintana Carlos Jericó Carlos Jericó José Antonio García Erce José Antonio García Erce José Antonio García Erce José Antonio García Erce |
| author_facet | Miguel Montoro Miguel Montoro Miguel Montoro Miguel Montoro Mercedes Cucala Ángel Lanas Ángel Lanas Ángel Lanas Ángel Lanas Cándido Villanueva Cándido Villanueva Antonio José Hervás Javier Alcedo Javier Alcedo Javier P. Gisbert Javier P. Gisbert Javier P. Gisbert Ángeles P. Aisa Luis Bujanda Luis Bujanda Luis Bujanda Xavier Calvet Xavier Calvet Xavier Calvet Fermín Mearin Óscar Murcia Pilar Canelles Santiago García López Santiago García López Carlos Martín de Argila Montserrat Planella Montserrat Planella Manuel Quintana Manuel Quintana Carlos Jericó Carlos Jericó José Antonio García Erce José Antonio García Erce José Antonio García Erce José Antonio García Erce |
| author_sort | Miguel Montoro |
| collection | DOAJ |
| description | Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., “don’t give two without review”). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs. |
| first_indexed | 2024-04-11T10:00:08Z |
| format | Article |
| id | doaj.art-f45e30f5e0514971a71fa6a1de629f04 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-11T10:00:08Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-f45e30f5e0514971a71fa6a1de629f042022-12-22T04:30:27ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-09-01910.3389/fmed.2022.903739903739Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management expertsMiguel Montoro0Miguel Montoro1Miguel Montoro2Miguel Montoro3Mercedes Cucala4Ángel Lanas5Ángel Lanas6Ángel Lanas7Ángel Lanas8Cándido Villanueva9Cándido Villanueva10Antonio José Hervás11Javier Alcedo12Javier Alcedo13Javier P. Gisbert14Javier P. Gisbert15Javier P. Gisbert16Ángeles P. Aisa17Luis Bujanda18Luis Bujanda19Luis Bujanda20Xavier Calvet21Xavier Calvet22Xavier Calvet23Fermín Mearin24Óscar Murcia25Pilar Canelles26Santiago García López27Santiago García López28Carlos Martín de Argila29Montserrat Planella30Montserrat Planella31Manuel Quintana32Manuel Quintana33Carlos Jericó34Carlos Jericó35José Antonio García Erce36José Antonio García Erce37José Antonio García Erce38José Antonio García Erce39Unidad de Gastroenterología, Hepatología y Nutrición, Hospital Universitario San Jorge, Huesca, SpainDepartamento de Medicina, Universidad de Zaragoza, Zaragoza, SpainInstituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, SpainInstituto de Investigación Sanitaria Aragón (IIS), Zaragoza, SpainVifor Pharma, Barcelona, SpainDepartamento de Medicina, Universidad de Zaragoza, Zaragoza, SpainInstituto de Investigación Sanitaria Aragón (IIS), Zaragoza, SpainServicio de Aparato Digestivo, Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, SpainCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, SpainCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, SpainServei de Digestiu, Hospital de la Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, SpainUnidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía de Córdoba, Córdoba, SpainDepartamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain0Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, SpainCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain1Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain2Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain3Servicio de Aparato Digestivo, Hospital Universitario Costa del Sol, Marbella, SpainCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain4Servicio de Aparato Digestivo, Hospital Universitario Donostia, Donostia, Spain5Instituto de Investigación Sanitaria Biodonostia, Universidad del País Vasco (UPV/EHU), Donostia, SpainCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain6Servei de Digestiu, Corporació Sanitaria Park Taulí, Sabadell, Spain7Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain8Servicio de Aparato Digestivo, Centro Médico Teknon, Barcelona, Spain9Servicio de Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain0Servicio de Aparato Digestivo, Hospital General Universitario de Valencia, Valencia, SpainDepartamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain0Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain1Servicio de Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain2Servei de Digestiu, Hospital Universitario Arnau de Vilanova, Lleida, Spain3Department of Medicine, Universidad de Lleida, Lleida, Spain4Servicio a Medicina Intensiva, Hospital Universitario La Paz (IdiPAZ), Madrid, Spain5PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain6Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain7Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain5PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain7Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain8Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain9Instituto Aragonés de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, SpainGastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., “don’t give two without review”). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs.https://www.frontiersin.org/articles/10.3389/fmed.2022.903739/fullanemiaferric carboxymaltose (FCM)gastrointestinal bleedingiron supplementationpatient blood managementtransfusion |
| spellingShingle | Miguel Montoro Miguel Montoro Miguel Montoro Miguel Montoro Mercedes Cucala Ángel Lanas Ángel Lanas Ángel Lanas Ángel Lanas Cándido Villanueva Cándido Villanueva Antonio José Hervás Javier Alcedo Javier Alcedo Javier P. Gisbert Javier P. Gisbert Javier P. Gisbert Ángeles P. Aisa Luis Bujanda Luis Bujanda Luis Bujanda Xavier Calvet Xavier Calvet Xavier Calvet Fermín Mearin Óscar Murcia Pilar Canelles Santiago García López Santiago García López Carlos Martín de Argila Montserrat Planella Montserrat Planella Manuel Quintana Manuel Quintana Carlos Jericó Carlos Jericó José Antonio García Erce José Antonio García Erce José Antonio García Erce José Antonio García Erce Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts Frontiers in Medicine anemia ferric carboxymaltose (FCM) gastrointestinal bleeding iron supplementation patient blood management transfusion |
| title | Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts |
| title_full | Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts |
| title_fullStr | Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts |
| title_full_unstemmed | Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts |
| title_short | Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts |
| title_sort | indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding an algorithm proposed by gastroenterologists and patient blood management experts |
| topic | anemia ferric carboxymaltose (FCM) gastrointestinal bleeding iron supplementation patient blood management transfusion |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.903739/full |
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