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Article: Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong

TitleJoint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong
Authors
Issue Date2018
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/
Citation
Hong Kong Medical Journal, 2018, v. 24, p. 416-422 How to Cite?
AbstractThe demand for blood products continues to grow in an unsustainable manner in Hong Kong. While anaemia associated with gastrointestinal bleeding (GIB) is the leading indication for transfusion, there is no local recommendation regarding best practices for transfusion. We aimed to provide evidence-based recommendations regarding management of anaemia in patients with acute and chronic GIB. We reviewed all original papers, meta-analyses, systematic reviews, or guidelines that were available in PubMed. For acute GIB, a restrictive transfusion strategy, targeting a haemoglobin threshold of 7 to 8 g/dL, should be adopted because overtransfusion is associated with significantly higher all-cause mortality and re-bleeding. A liberal transfusion strategy should only be considered in patients with co-existing symptomatic coronary artery disease, targeting a haemoglobin threshold of 9 to 10 g/dL. When acute GIB settles, patients should be prescribed iron supplements if iron deficiency is present. For chronic GIB, iron stores should be replenished aggressively via iron supplementation before consideration of blood transfusion, except in patients with symptoms of severe anaemia. Oral iron replacement is the preferred first-line therapy, while intravenous iron is indicated for patients with inflammatory bowel disease, poor response or poor tolerability to oral iron, and in whom a rapid correction of iron deficit is preferred. Intravenous iron is underutilised and the risk of anaphylactic reaction to current preparations is extremely low. These recommendations are provided to local clinicians to facilitate judicious and appropriate use of red cell products and iron replacement therapy in patients with GIB.
Persistent Identifierhttp://hdl.handle.net/10722/260537
ISSN
2017 Impact Factor: 1.226
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorMak, LY-
dc.contributor.authorLau, CW-
dc.contributor.authorHui, YT-
dc.contributor.authorNg, C-
dc.contributor.authorShan, E-
dc.contributor.authorLi, MKK-
dc.contributor.authorLau, JYW-
dc.contributor.authorChiu, PWY-
dc.contributor.authorLeong, HT-
dc.contributor.authorHo, J-
dc.contributor.authorWu, JCY-
dc.contributor.authorLee, CK-
dc.contributor.authorLeung, WK-
dc.date.accessioned2018-09-14T08:43:20Z-
dc.date.available2018-09-14T08:43:20Z-
dc.date.issued2018-
dc.identifier.citationHong Kong Medical Journal, 2018, v. 24, p. 416-422-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/260537-
dc.description.abstractThe demand for blood products continues to grow in an unsustainable manner in Hong Kong. While anaemia associated with gastrointestinal bleeding (GIB) is the leading indication for transfusion, there is no local recommendation regarding best practices for transfusion. We aimed to provide evidence-based recommendations regarding management of anaemia in patients with acute and chronic GIB. We reviewed all original papers, meta-analyses, systematic reviews, or guidelines that were available in PubMed. For acute GIB, a restrictive transfusion strategy, targeting a haemoglobin threshold of 7 to 8 g/dL, should be adopted because overtransfusion is associated with significantly higher all-cause mortality and re-bleeding. A liberal transfusion strategy should only be considered in patients with co-existing symptomatic coronary artery disease, targeting a haemoglobin threshold of 9 to 10 g/dL. When acute GIB settles, patients should be prescribed iron supplements if iron deficiency is present. For chronic GIB, iron stores should be replenished aggressively via iron supplementation before consideration of blood transfusion, except in patients with symptoms of severe anaemia. Oral iron replacement is the preferred first-line therapy, while intravenous iron is indicated for patients with inflammatory bowel disease, poor response or poor tolerability to oral iron, and in whom a rapid correction of iron deficit is preferred. Intravenous iron is underutilised and the risk of anaphylactic reaction to current preparations is extremely low. These recommendations are provided to local clinicians to facilitate judicious and appropriate use of red cell products and iron replacement therapy in patients with GIB.-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/-
dc.relation.ispartofHong Kong Medical Journal-
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleJoint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong-
dc.typeArticle-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.authorityLeung, WK=rp01479-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.12809/hkmj187348-
dc.identifier.hkuros291661-
dc.identifier.volume24-
dc.identifier.spage416-
dc.identifier.epage422-
dc.publisher.placeHong Kong-

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