The optimal use of blood components in the management of gastrointestinal bleeding.

Acute gastrointestinal bleeding accounts for 5,000 deaths per annum in the UK and is the second-most common indication for transfusion of blood components. Transfusion of blood components is integral to management of these patients. Recent years have seen an expansion in the evidence base for their use in this population and this review aims to provide up-to-date guidance on the use of red cells, plasma, platelets, sources of concentrated fibrinogen and adjuncts such as antifibrinolytic agents in patients with acute gastrointestinal haemorrhage. Key considerations include whether or not it is appropriate to extrapolate from studies in trauma patients to the GI bleeding population, whether restrictive red cell transfusion is appropriate for all patients and whether the presence or absence of liver disease has implications for our transfusion practice. Clinical evidence now favours restrictive transfusion of red blood cells in the haemodynamically stable bleeding patient, but there remain significant evidence gaps concerning the use of plasma, platelets and adjunctive measures.