09 March 2016

Study confirms bleeding obvious

Patients with bleeding of the upper gastrointestinal tract (UGIT) due to ulcers or inflammation are set for improved outcomes thanks to recently completed WA Health research.

The research will help doctors assess who should – and who should not – be transfused.

The findings of the three-year study, published in a recent edition of the peer-reviewed medical journal Transfusion, will enable doctors to predict more accurately those likely to benefit from a blood transfusion and – more importantly – identify those for whom a transfusion of red blood cells, frozen fresh plasma or platelets will increase the risk of further bleeding or death.

One of the study’s authors, Head of Gastroenterology at Fiona Stanley Hospital John Olynyk, said bleeding of the UGIT was one of the most common reasons for attending a hospital emergency department and accounted for around 1100 presentations to WA EDs every year.

Most of these patients undergo an endoscopic procedure to stem the bleeding and receive some form of blood product – or combination of blood products – prior to the procedure.

But not everybody needs blood products and for some patients, being given blood products can actually be harmful,” Professor Olynyk said.

Among those most likely to be adversely impacted by blood transfusion were patients with a haemoglobin level exceeding 90grams per litre on admission.

Professor Olynyk and his co-researchers found that such patients were 10 times more likely to experience further bleeding if they received an early transfusion of red blood cells and that the more cells they received, the greater their risk of further bleeding and associated complications.

Likewise, some patients were found to have an increased risk of adverse health outcomes or even death when transfused with at least three units of platelets or five units of fresh frozen plasma.

Professor Olynyk said the study highlighted the need for a more judicious approach to the administration of blood products, where therapy was tailored to the individual patient.

"Unless a patient has major UGIT bleeding, red blood cells and plasma should not be given as a matter of course," he said.

The study was based on the retrospective de-identified patient data of more than 2000 UGIT patients from Fremantle, Royal Perth and Sir Charles Gairdner hospitals from 2008 to 2010 inclusive.

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