Blood transfusion does not improve digestive bleeding by esophageal varices
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Blood transfusion did not significantly improve the prognosis of patients with digestive bleeding by esophageal varices, according to a study in Open Access Journal of Gastroenterology.
“Digestive bleeding by rupture of esophageal varices is one of the most formidable complications of cirrhosis, frequently encountered in hospitals, with a sometimes high mortality rate,” researchers from the department of hepatogastroenterology, Teaching Hospital Gabriel Touré in Bamako, Mali, wrote. “The prognosis can be improved by acquiring more efficient resuscitation means. Universal vaccination against [hepatitis B virus (HBV)], the leading cause of cirrhosis in Mali, could reduce the frequency of this condition and mortality from esophageal varices rupture.”
Investigators performed a prospective study of 77 patients in the department of hepato-gastroenterology of Gabriel Toure’ Hospital, with gastrointestinal bleeding by a rupture of esophageal varices. Patients’ average age was 46.58 years.
Researchers compared patients who received a transfusion with patients who did not receive a transfusion. Clinical examination included history (jaundice, hematemesis, melena, rectorragia and any other known pathology) and signs of HTP and hepatocellular insufficiency. Biological examinations evaluated hemodynamic resonance including hemoglobin levels, hematocrite levels, creatininemia and hepatocellular function including TP, total bilirubinemia and protides electrophoresis.
Signs of portal hypertension and liver morphology were evaluated with an abdominal ultrasound.
“At the end of this procedure, a blood transfusion was indicated with systolic blood pressure of 90 mm Hg or less and/or hemoglobin levels below 7 g/dL, plus or minus a pulse greater than 110 pulses per minute,” investigators wrote. “Ligation of esophageal varicose veins was performed in some patients. Upper gastrointestinal endoscopy looked for criteria attributing digestive hemorrhage to rupture of esophageal varices.”
The prevalence of varices bleeding was 5.5% among hospitalized patients during the same period, according to study data. Further, 63.2% of patients had clinical anemia at admission 58.4% had low arterial pressure and 50.6% had a hemoglobin rate less than 7 g/dL.
According to researchers, 47 patients needed a blood transfusion. The mortality rate was 23.4% and was similar in both groups (P = .099).
“Early rebleeding was significantly observed in the case of transfusion (P = .0452),” the investigators wrote. “Hepatic encephalopathy was the leading cause of death of our patients with 72.2%.”
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