Abstract
The hematologic management of gastrointestinal bleeding requires evaluation of the underlying cause, associated diseases that can exacerbate the bleeding, and identification of related or unrelated coagulation abnormalities. Common causes of gastrointestinal bleeding include peptic ulcer disease, gastritis, esophagitis, esophageal varices, various gastrointestinal malignancies, diverticulosis, and Mallory-Weiss tears. These gastrointestinal abnormalities can cause significant bleeding in patients with normal hemostatic mechanisms. Moreover, hemostatic abnormalities can exacerbate the gastrointestinal bleeding. This article discusses management of bleeding in patients with and without underlying hemostatic abnormalities.
This article is divided into five sections. The first section addresses the use of packed erythrocyte transfusion in a bleeding patient, including the risks of erythrocyte transfusion, the evidence for the indications for erythrocyte transfusion, and recommendations for transfusion. The second section reviews coagulopathy and platelet disorders associated with liver disease that can occur in patients presenting with gastrointestinal bleeding. Disorders such as renal failure and primary hemostatic problems that can increase the bleeding risk in a patient with an underlying gastrointestinal abnormality are briefly reviewed. The third section addresses thrombocytopenia and the relationship between platelet count and bleeding. The fourth section reviews the use of platelet transfusions and fresh frozen plasma (FFP). In the last section, optimal management of patients taking warfarin or aspirin who present with a gastrointestinal bleed is briefly reviewed.