Canterbury DHB


Acute bleeding in the adult patient who declines blood products


Please refer to flowchart: Acute Bleeding in Patients who Decline Blood Products. After the individual’s particular views towards blood products etc have been established, and if the patient has refused to consent to the administration of various blood products and/or other interventions obtained, the medical management can be summarised as follows (adapted from [3]):

Enhance haemoglobin production. Supplementation of vitamin B12 (e.g. 1000 mcg IM on days 1, 3 and 5), folic acid (5 mg PO daily) and intravenous iron (e.g. Iron polymaltose 1000 mg) can help to speed up the process of haemoglobin production. Anaemic patients with normal or even elevated endogenous erythropoietin levels may possibly benefit from high-dose Epo (up to 300-500 units/kg per day [3]). However, the use of Epo in this setting has been published in case reports and case series only and there is no evidence to recommend an optimal dose in this setting. Various regimens have been tried. A study looking at the effect of Epo on correcting anaemia post-peptic ulcer bleeding found a significant difference in median haematocrit after 14 days when erythropoietin (20,000 IU administered subcutaneously on days 0, 4, and 6) was given along with intramuscular iron compared with iron alone [12]. The rate of haemoglobin increase after Epo varies widely among patients. A study in orthopaedic patients reported an average increase on 14.4 g/L per week [13]. The haemoglobin, haematocrit and reticulocyte count can be used to assess response e.g. at day 7 and weekly thereafter.

About this Canterbury DHB document (47848):

Document Owner:

Julia Czuprynska and Richard Seigne (see Who's Who)

Last Reviewed:

June 2019

Next Review:

June 2022


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Topic Code: 47848