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
Montoro, Miguel (Instituto de Investigación Sanitaria de Aragón)
Cucala, Mercedes (Vifor Pharma)
Lanas, Angel (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas)
Villanueva, Càndid (Institut d'Investigació Biomèdica Sant Pau)
Hervás, Antonio José (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Alcedo, Javier (Hospital Universitario Miguel Servet (Saragossa))
P. Gisbert, Javier (Instituto de Investigación Hospital Universitario de la Princesa)
Aisa, Ángeles P. (Hospital Costa del Sol (Marbella))
Bujanda, Luis (Universidad del País Vasco. Instituto de Investigación Sanitaria Biodonostia)
Calvet, Xavier (Universitat Autònoma de Barcelona. Departament de Medicina)
Mearin, Fermín 1956- (Centro Médico Teknon. Servicio de Aparato Digestivo)
Murcia, Óscar (Hospital General Universitario de Alicante (Alacant, País Valencià))
Canelles, Pilar (Hospital General Universitario de Valencia. Servicio de Aparato Digestivo)
García-López, Santiago (Hospital Universitario Miguel Servet (Saragossa))
Martín de Argila, Carlos (Hospital Universitario Ramón y Cajal (Madrid))
Planella, Montserrat (Universitat de Lleida. Facultat de Medicina)
Quintana Diaz, Manuel (Hospital Universitario La Paz (Madrid))
Jericó, Carlos (Grupo Español de Rehabilitación Multimodal)
García Erce, José Antonio (Instituto Aragonés de Ciencias de la Salud (IACS))
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Subject:	Anemia ; Ferric carboxymaltose (FCM) ; Gastrointestinal bleeding ; Iron supplementation ; Patient blood management ; Transfusion
Published in:	Frontiers in Medicine, Vol. 9 (september 2022) , p. 903739, ISSN 2296-858X

DOI: 10.3389/fmed.2022.903739
PMID: 36186804

16 p, 1.9 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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