Red Blood Cell Transfusions and Iron Therapy for Patients Presenting With Acute Upper Gastrointestinal Bleeding: A Survey of Gastroenterologists
Bibliographic record
Abstract
Introduction: There currently exists only 1 completed RCT to evaluate transfusions in patients with acute upper gastrointestinal bleeding (UGIB). As such, physician transfusion practices in UGIB are largely based on experience and can vary considerably. Methods: A web-based survey was sent to 500 gastroenterologists across Canada. The survey included simulated cases (see Table 1) where physicians were required to choose transfusion thresholds and multiple-choice questions related to iron therapy and current guidelines. Descriptive and inferential statistics (Chi-square and t-tests) were carried out.Table 1Results: The overall questionnaire response rate was 41%. Transfusion practices differed by up to 50g/L in terms of trigger hemoglobin (HgB) thresholds for transfusion. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean HgB of 86.7 g/L vs. 71.0 g/L, p < 0.0001). More than half of respondents (57%) transfused 2 units of RBC's as initial management. Patients with coronary artery disease (mean HgB of 84.0 g/L vs. 71.0 g/L, p < 0.0001) or cirrhosis (mean HgB of 74.4 g/L vs. 71.0 g/L, p < 0.01) were transfused at higher thresholds than healthy patients, as were patients on warfarin (mean HgB of 75.3 g/L vs. 71.0 g/L, p < 0.001). Only 15% or respondents would transfuse more liberally if the patient was on dabigatran, rivaroxaban, or apixaban. Over half (56%) of respondents felt more likely to be held legally responsible for the complications related to “under-transfusing” than the complications associated with “over-transfusing”. Lastly, Less than 15% of gastroenterologists prescribe iron to patients with UGIB who are anemic upon discharge. Conclusion: Healthy and hemodynamically stable patients are being transfused at a HgB below 70g/L while higher thresholds are used in patients who are unstable or who have underlying cardiac disease or cirrhosis. Many clinicians are not following current guidelines and are still transfusing patients at a HgB threshold of 100g/L. Few gastroenterologists are regularly prescribing iron on discharge to anemic patients. Overall, the transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".