000119717 001__ 119717 000119717 005__ 20240319081016.0 000119717 0247_ $$2doi$$a10.3389/fmed.2022.903739 000119717 0248_ $$2sideral$$a130544 000119717 037__ $$aART-2022-130544 000119717 041__ $$aeng 000119717 100__ $$0(orcid)0000-0001-7676-9842$$aMontoro, Miguel$$uUniversidad de Zaragoza 000119717 245__ $$aIndications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts 000119717 260__ $$c2022 000119717 5060_ $$aAccess copy available to the general public$$fUnrestricted 000119717 5203_ $$aGastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., “don’t give two without review”). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs. 000119717 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc$$uhttp://creativecommons.org/licenses/by-nc/3.0/es/ 000119717 590__ $$a3.9$$b2022 000119717 592__ $$a0.926$$b2022 000119717 591__ $$aMEDICINE, GENERAL & INTERNAL$$b58 / 169 = 0.343$$c2022$$dQ2$$eT2 000119717 593__ $$aMedicine (miscellaneous)$$c2022$$dQ1 000119717 594__ $$a3.6$$b2022 000119717 655_4 $$ainfo:eu-repo/semantics/review$$vinfo:eu-repo/semantics/publishedVersion 000119717 700__ $$aCucala, Mercedes 000119717 700__ $$0(orcid)0000-0001-5932-2889$$aLanas, Ángel$$uUniversidad de Zaragoza 000119717 700__ $$aVillanueva, Cándido 000119717 700__ $$aHervás, Antonio José 000119717 700__ $$aAlcedo, Javier 000119717 700__ $$aGisbert, Javier P. 000119717 700__ $$aAisa, Ángeles P. 000119717 700__ $$aBujanda, Luis 000119717 700__ $$aCalvet, Xavier 000119717 700__ $$aMearin, Fermín 000119717 700__ $$aMurcia, Óscar 000119717 700__ $$aCanelles, Pilar 000119717 700__ $$0(orcid)0000-0003-3970-5457$$aGarcía López, Santiago$$uUniversidad de Zaragoza 000119717 700__ $$aMartín de Argila, Carlos 000119717 700__ $$aPlanella, Montserrat 000119717 700__ $$aQuintana, Manuel 000119717 700__ $$aJericó, Carlos 000119717 700__ $$aGarcía Erce, José Antonio 000119717 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina 000119717 773__ $$g9 (2022), 90373 [16 pp]$$pFront. med.$$tFrontiers in Medicine$$x2296-858X 000119717 8564_ $$s1969447$$uhttps://zaguan.unizar.es/record/119717/files/texto_completo.pdf$$yVersión publicada 000119717 8564_ $$s2323344$$uhttps://zaguan.unizar.es/record/119717/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000119717 909CO $$ooai:zaguan.unizar.es:119717$$particulos$$pdriver 000119717 951__ $$a2024-03-18-15:37:46 000119717 980__ $$aARTICLE