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GI Bleeding-Transfusion Threshold — ESEGH MCQ

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ModerateGastroenterologyGI Bleeding-Transfusion ThresholdESEGH

A 54‑year‑old patient presents with an acute upper gastrointestinal bleed. After initial fluid resuscitation he is haemodynamically stable (BP 135/82 mmHg, HR 82 bpm). His haemoglobin is 7.2 g/dL. Gastroenterology review and endoscopy are planned within 24 hours. There is no evidence of active bleeding or organ ischaemia. What is the most appropriate transfusion strategy?

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Correct answer: C — Withhold red blood cell transfusion and monitor; transfuse only if haemoglobin falls below 7 g/dL or signs of organ ischaemia develop

UK (NICE CG141) and EU (ESGE) guidance endorse a restrictive red cell transfusion strategy in stable acute upper GI bleeding, with transfusion threshold at or below 7 g/dL (70 g/L) and target post‑transfusion Hb of 7–9 g/dL. This patient’s Hb of 7.2 g/dL in the absence of active bleeding or haemodynamic compromise does not meet criteria for transfusion. Option C correctly reflects current best practice. Options A and B are overly liberal and unsupported by guideline evidence. Option D uses a non‑guideline trigger (lactate) that is not recommended; Option E is inappropriate as platelet transfusion is not indicated in platelet‑stable, non‑bleeding patients.

Reference: NICE CG141 (2012, updated 2016): acute upper gastrointestinal bleeding, transfusion guidance; ESGE Guideline 2026: Non‑variceal upper GI hemorrhage, restrictive transfusion strategy, https://www.nice.org.uk/guidance/cg141/chapter/Recommendations