Variceal Bleeding Transfusion — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGastroenterology & HepatologyVariceal Bleeding TransfusionRACP Adult Medicine

A 50-year-old man with known cirrhosis is listed for liver transplantation. He develops acute variceal bleeding requiring transfusion of 4 units of packed red blood cells. What is the restrictive transfusion threshold recommended in acute variceal bleeding?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — 70 g/L

A restrictive transfusion strategy targeting haemoglobin 70–80 g/L is recommended in variceal bleeding (Villanueva et al., NEJM 2013). Over-transfusion to higher haemoglobin levels increases portal pressure, worsens bleeding, and increases mortality. The transfusion trigger is Hb <70 g/L. Exceptions include patients with active cardiovascular disease, where a higher threshold (80–90 g/L) may be appropriate.

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