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Variceal bleeding worsened by liberal transfusion — SCE Acute Medicine MCQ

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HardAcute GI PresentationsVariceal bleeding worsened by liberal transfusionSCE Acute Medicine

A 62-year-old man with alcohol-related cirrhosis is admitted with haematemesis. He is transfused to Hb 104 g/L after two units, then becomes more breathless and rebleeds. BP is 104/62 mmHg, HR 116 and endoscopy confirms oesophageal varices. What is the most likely mechanism by which excessive transfusion worsened the bleed?

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Correct answer: D — Raised portal pressure after liberal red-cell transfusion

In variceal bleeding, liberal transfusion can increase portal pressure and rebleeding; a restrictive strategy is usually preferred unless there is exsanguinating haemorrhage or major comorbidity. Packed red cells do not directly inhibit platelets as the main mechanism. Vitamin K depletion is not an immediate effect of red-cell transfusion. The pearl is that resuscitation targets in variceal bleeding are deliberately conservative compared with many other shock states.

Reference: BSG variceal haemorrhage guideline, NICE NG50