Chronic anemia due to gastrointestinal bleeding: when do gastroenterologists transfuse?

Background: The hypothesis is that decision-making for transfusion varies considerably among gastroenterologists. The aim is to identify preferences and predictors of transfusion decision-making in chronic anemia. Study design and methods: Between February and April of 2015, a computerized adaptive choice-based conjoint survey was administered to gastroenterologists in the Netherlands. The survey included seven patient attributes: hemoglobin levels, hemoglobin stability, age, iron indices, the presence of anemia-related symptoms, cardiovascular comorbidities, and the number of transfusions in the past half year. Predictors of transfusion preferences were assessed by multivariable regression. Results: 113 gastroenterologists completed the survey (response rate=29%; mean age=47 years; 24% women). Absolute hemoglobin level was the most important incentive of transfusion, accounting for 42% of decision-making, followed by age (15%), hemoglobin stability (12%), anemia-related symptoms (10%), and cardiovascular comorbidities (10%). A hemoglobin level > 9.6g/dL is an inflection point, where gastroenterologists would not prescribe transfusions. Age of the patient is more important in the decision-making process to younger gastroenterologists (OR -2.9, 95% CI -5.3 to -0.5). Conclusion: Absolute hemoglobin level is the most important factor to transfusion decision-making. This is contradictory to transfusion guidelines for chronic anemia which address the importance of symptoms.