THE IMPACT OF HIV TESTING ON BLOOD UTILIZATION IN THE INTENSIVE-CARE UNIT IN PATIENTS WITH GASTROINTESTINAL-BLEEDING

Objective. To determine whether the AIDS epidemic has influenced physi cian use of blood products in intensive care unit management of gastro intestinal hemorrhage. Methods: Retrospective chart review of 148 pati ents with gastrointestinal hemorrhage admitted to the intensive care u nit. Forty-eight patients were admitted before the onset of HIV testin g of the blood supply (group 1) and 100 were admitted after HIV testin g was begun (group 2). Results. Of the 148 patients, 18 (eight in grou p 1, ten in group 2) were not transfused and had higher median hemoglo bin levels on admission and higher median hemoglobin nadirs during hos pitalization than patients who were transfused. Transfused patients in group 2 did not have significantly lower median hemoglobin levels on admission [7.9 (4.2-12.5) g/dl] than transfused patients in group 1 [9 .3 (4.1-13.5) g/dl] (p = 0.058). Patients in group 2 had significantly lower median hemoglobin concentrations prior to the first transfusion event [7.4 (4.2-10.3) g/dl] than those in group 1 [8.5 (4.2-12.1) g/d l] (p = 0.016). There were no significant differences between the two groups in terms of the total number of units of packed red blood cells , fresh frozen plasma or platelets transfused. Neither was any signifi cant difference in mortality observed, with 11 patients (22.9%) dying in group 1 and 23 patients (23.0%) dying in group 2. The cause of deat h in 13 of the 34 patients was related to cardiovascular and hemodynam ic complications of gatrointestinal bleeding. There was no significant difference in mean age (group 1: 60.5 years; group 2: 59.4 years) or mean hemoglobin nadir (group 1: 7.0 g/dl, group 2: 7.1 g/dl) among tho se who died in the two groups. Conclusions: These data indicate that p hysicians are transfusing patients at lower hemoglobin levels than the y did before the beginning of HIV testing. However, there has been no decrease in the total median amount of blood products transfused since that time. This change in practice may be due to increased concern ab out HIV transmission through blood products and suggests the need for greater awareness of existing transfusion guidelines.