Variceal Bleeding Transfusion — RACP Adult Medicine MCQ

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ModerateEmergency MedicineVariceal Bleeding TransfusionRACP Adult Medicine

A 58-year-old man with alcoholic liver disease presents with acute variceal bleeding. After resuscitation and endoscopic band ligation, what is the target haemoglobin for transfusion in acute variceal bleeding?

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Correct answer: B — 70–80 g/L (restrictive strategy)

A restrictive transfusion strategy targeting haemoglobin 70–80 g/L is recommended in acute variceal bleeding (Villanueva trial, 2013). Liberal transfusion (>90 g/L) was associated with increased rebleeding and mortality, likely due to increased portal pressure from volume expansion. Exceptions include patients with ischaemic heart disease or active haemodynamic instability, where a higher threshold may be appropriate.

Reference: eTG – 2025 – Gastrointestinal; Baveno VII – 2022 – Portal Hypertension Consensus