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Hemoglobin Monitoring in Acute Gastrointestinal Bleeding: Are We Monitoring Blood Counts Too Frequently?

  • Isaac Jaben
    Affiliations
    Department of Internal Medicine, Medical University of South Carolina, Charleston

    Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston
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  • Roula Sasso
    Affiliations
    Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston
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  • Don C. Rockey
    Correspondence
    Requests for reprints should be addressed to Don C. Rockey, MD, Digestive Disease Research Center, Medical University of South Carolina, 96 Jonathon Lucas Street, Suite 908, Charleston, SC 29425.
    Affiliations
    Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston

    Digestive Disease Research Center, Medical University of South Carolina, Charleston
    Search for articles by this author
Published:November 08, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.056

      Abstract

      Background

      Gastrointestinal hemorrhage is a common cause of hospital admission. However, there are little data to inform practice around blood count monitoring—a cornerstone of management. We hypothesized that more frequent testing leads to increased resource utilization without improvement in patient outcomes.

      Methods

      This retrospective observational cohort study examined all patients admitted to a large academic medical institution primarily for gastrointestinal bleeding between July 10, 2014, and January 1, 2018. We identified 1150 patients admitted for gastrointestinal hemorrhage. Patients under 18, who developed bleeding while hospitalized, or who were transferred were excluded. The primary outcome was the number of complete blood counts collected in the first 48 hours of admission. Propensity matched analysis was performed to assess blood transfusion, units of blood transfused, time-to-endoscopy, mortality, and 30-day readmission rate.

      Results

      On average, 5.6 complete blood counts were collected in the first 48 hours; 67% of the cohort was transfused (average of 2.6 units of packed red blood cells). When matched for comorbidity, anticoagulant use, location (ward vs. intensive care unit), vital signs, hemoglobin level, and international normalized ratio, patients having more frequent monitoring had similar hospital length of stay and mortality rates, but were more likely to receive a blood transfusion (0.93 vs 0.76, P < .05), and if transfused, receive more blood (4 vs 2 units, P < .05).

      Conclusions

      Blood count monitoring occurs more frequently than is likely necessary, is associated with a higher likelihood of blood transfusion, and does not affect patient outcomes, suggesting patient care may be improved by less frequent monitoring.

      Keywords

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