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Title: Does early endoscopic intervention reduce the need for blood transfusion in patient with gastrointestinal bleeding?
Author: Ferman, Mutaz
Sheikh, M.
Shawki, Marwan
Leung, E.
Al-Ansari, Mohammed
Issue Date: 2017
Conference Name: GESA AGW 2017
Conference Date: August 20-22, 2017
Conference Place: Gold Coast, Queensland
Abstract: Acute gastrointestinal bleeding (GIB) is a gastroenterological emergency with a mortality of 6%-13%.1 Blood transfusion may be lifesaving in massive bleedings, Previous data have shown that restrictive transfusion strategy is effective in resuscitation in GIB setting. 2 However this is controversial in patient cardiovascular comorbidities. Most patients with GIB can be effectively managed endoscopically within 24 hours of presentation, 3 this mainly depends on particular resources. Objective: To assess patients who presented with GIB, in relation to the time to have endoscopy and the need for blood transfusion. Hospital coding database were used to identify patients presented with hematemesis and / or melena or hamematochesia, from July 2015 to July 2016, we extracted data related to patients demographic. Blood results and procedure related details from the electronically saved patient’s records. A total cohort of 92 patients who presented to our Centre with GIB during 12 months period, were found eligible to the study, 42 were females, and the median age was 67 years. The presenting complaints include hematemesis (n=24), melena (n=36), hematemesis and melena (n=19), hematochezia (n=15), microcytic anemia (n=13) and syncopal episode (n=5). 73 (79%) patients presented with single compliant (hematemesis n=22, melena n=26, hematemesis and melena n=16 and PR bleeding n=9) 18 (20%) patients presented with two complaints (PR bleeding and anemia n=1, melena and anemia n=8, PR bleeding and syncope n= 3, melena and syncope n= 1, hematemesis and melena and anemia n=2, hematemesis and anemia n= 1, hematemesis and PR bleeding n= 1, hematemesis and melena and PR bleeding n= 1) and 1(1%) patient had three complaints (melena, anemia and syncope). 25/92 patients (27%) noted to have history of heavy alcohol intake, including 15 cirrhotic patients. 25 patients did not have inpatient endoscopy, including 9 patients were stabilized and discharged and had it as an outpatient, others (16 patients), did not have endoscopic procedure because of self-discharge (n=3), private referral (n=2), transfer to different hospital (n=1), conservative management (n=10). Considering the inpatient procedures, gastroscopy was performed in 52 patients (78%), 5 patients had colonoscopy (8%), flexible sigmoidoscopy performed in 3 patients (4%), and 7 patients had combined gastroscopy and colonoscopy (10%). In 92 patient who presented with GIB, hemoglobin level (Hb) at time of presentation was below 7g/dl in 11 patients (12%), 17 patients (18%) with Hb between 7-8g/ dl, and 64 patients (70%) had Hb more than 8g//dl. 38/92 patients were given blood transfusion (41%), including 14 patients (37%) had Hb above 8g/dl at time of transfusion. Considering the time to endoscopic procedure in 67 patients who had inpatient scope, 12 patients had their endoscopic procedure in less than 12 hours, including 5 patients were given blood transfusion, and 55 patients had their procedure in more than 12 hours, including 31 patients were given blood transfusion (p value of 0.354). Furthermore, with assessing the transfusion cohort in the two groups (<12 hours and >12 hours’ time to procedure), 1 out of 5 and 19 out of 31 respectively had Hb below 8g/dl, at time of transfusion (p value 0.633). The amount of transfused units ranged from one to six units of packed red blood cells with an average of 2.5 units per patient. In this study, most of patients with GIB underwent endoscopic procedures, and more than one third of them had blood transfusion, however only small number presented with low Hb (<7g/dl). There was a trend of giving more RBC if we delay the procedure for more than 12 hours but this did not reach statistical significance. This might be confounded by the rate and strategy followed for blood transfusion. When we assessed the blood transfusion cause in the second groups, there was a trend of giving blood transfusion for Hb >8gm in the early procedure group but again did not reach statistical significance. The above results may elude to saving on blood transfusion can be optimised if we use the restrictive transfusion strategy. More prospective studies are warranted to further assess the role of early endoscopic procedure in patients with GIB.
Internal ID Number: 01105
Health Subject: COLONOSCOPY
Type: Conference
Appears in Collections:Research Output

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