Haemorrhage and blood products

Question 1

symptoms of upper GI bleeding

Answer 1

haematemessi
altered bowel habit
abdominal pain
pre-syncope/syncope

Question 2

clinical signs of upper GI bleeding

Answer 2

Tachycardia

Hypotension

Abdominal tenderness

Malaena: black, tarry stools caused by the presence of digested blood.

Haematochezia: the passage of fresh red blood per rectum, which can occur in the context of profuse upper gastrointestinal haemorrhage due to rapid transit of blood through the gastrointestinal tract.

Check for signs of liver disease

Question 3

investigations for upper GI bleeding

Answer 3

Endoscopy, after calculating blatchford score, 0 can be managed in the community

Rockall score: risk of ongoing bleeding and death

PPI

Terlipressin

Cipofloxacin

Question 4

major haemorrhage definition

Answer 4

Loss of more than one blood volume within 24 hours (around 70 mL/kg, >5 litres in a 70 kg adult)

50% of total blood volume lost in less than 3 hours

Bleeding in excess of 150 mL/minute.

Question 5

red cell transfusion criteria

Answer 5

Red cell transfusion is usually necessary if 30–40% blood volume is lost, and rapid loss of >40% is immediately life threatening

Question 6

complications of massive haemorrhage

Answer 6

hypothermia
hypocalcaemia
hyperkalaemia
delayed type transfusion reactions
transfusion related lung injury
coagulopathy

Question 7

causes of upper GI bleeds

Answer 7

Oesophageal/gastric varices
Peptic ulcer disease (H. pylori, NSAID use, smoking)
Malignancy
Aorto-enteric fistula (previous abdominal aortic aneurysm or an aortic graft)
Angiodysplasia
Mallory Weiss tear

Question 8

management of upper GI bleed

Answer 8

IV fluid resus and blood transfusion
NBM and supplemental oxygen
IV PPI
IV terlipressin and ax in variceal bleeding
upper GI endoscopy

Question 9

rockall score

Answer 9

risk assessment tool that predicts mortality in these patients

It can be calculated pre-endoscopy (maximum score 7) or post endoscopy (maximum score 11).

Patients who score >0 are recommended to have an inpatient OGD whereas those scoring 0 can have an urgent outpatient OGD.

Question 10

glasgow-blatchford score

Answer 10

The Glasgow-Blatchford score is preferred by NICE pre-endoscopy for deciding upon timing of the procedure.
Again those scoring<0 may be suitable for outpatient OGD.