Càndid Villanueva and colleagues conducted a randomized clinical trial in patients with upper gastrointestinal bleeding. Patients were randomly allocated to restrictive transfusion strategy of 7 g/dL or liberal transfusion strategy of 9 g/dL. Patients in the restrictive group had statistically significant absolute reduction of mortality of 4% and relative reduction of 45% in death at 45 days. Recurrent bleeding was also less frequent in restrictive group as were many complications. The excellent editorial by Lauren Laine points out that the risk of death was not different between patients with portal hypertension or peptic ulcer disease. However, it appears that reduction in bleeding associated with restrictive transfusion might explain, in part, the superior outcome.
A must read for NATA members and visitors interested in red blood cell transfusion.
– Jeffrey L. Carson