A study by researchers at the Nuffield Department of Medicine in The Lancet has tackled the controversial question of when to begin blood transfusions in cases where the blood loss is not life threatening.
Previous work suggests that beginning blood transfusions when haemoglobin concentrations fall below a low rather than a high threshold is safer as well as economically beneficial. But there are no large-scale randomised controlled trials to support this conclusion, limiting its applicability.
Dr Vipul Jairath and his colleagues tackled this problem by carrying out a randomised feasibility trial which included 936 patients across six university hospitals in the UK. The trial compared the effectiveness of a restrictive (transfusion when haemoglobin concentrations fell below 80 g/L) versus a liberal (transfusion when haemoglobin concentrations fell below 100 g/L) for patients with acute upper gastrointestinal bleeding.
There were no statistically significant differences in clinical outcomes, even though there was a trend towards the patients in the ‘restrictive’ group receiving fewer red blood transfusions. ‘The question of which policy to use is important, and the answer could have an effect on outcomes and economics of treatment,’ said Professor Timothy Rockall at the Royal Surrey County Hospital, ‘Although the results of this trial should not be used to inform changes in present guidance, but should be viewed as an important precursor to a large randomised controlled trial.’