Clinical Guidelines are like a moving target, and rightfully so, since they change as more evidence accumulates in the spirit of evidence-based medicine. In the 2019 update by the International Consensus group in the setting of non-variceal GI bleed, the recommendation given was as follows:
“In patients with acute UGIB without underlying cardiovascular disease, we suggest giving blood transfusions for those with a hemoglobin level <80 g/L.” Or 8 g/L.
This used to be a 7 g/dL threshold on the previous 2010 guideline update. Though they do mention however that the evidence for this recommendation was weak. They recommend a higher threshold for people with known cardiovascular disease or though level, though not specific.
My take is if Hemoglobin has dropped under 8 with recent GI bleed , it’s probably going to drop further as extravascular fluid continues to move intravascularly after blood loss. IV fluids given for initial resuscitation will cause hemodilution too.
Read more here from the 2019 non-variceal GI bleed guidelines
And remember it takes time for Hemoglobin to drop after a GI bleed happens.
