The Adjusted Blood Requirement Index (ABRI) can be used to evaluate a patient with upper gastrointestinal bleeding in the setting of portal hypertension.
Parameters:
(1) initial hematocrit in percent (as a whole number from 0 to 100)
(2) final hematocrit in percent (as a whole number from 0 to 100)
(3) number of units of blood transfused
ABRI =
= (number of units of packed RBCs transfused) / ((final hematocrit) - (initial hematocrit) + 0.01)
where:
• The 0.01 is allows for the initial and final hematocrits are the same.
• The hemoglobin and hematocrit should be monitored every 6 hours for the first 2 days then every 12 hours until the bleeding is under control.
• The target hematocrit for a patient without cardiopulmonary disease who has had active GI bleeding is 24 percent (a hemoglobin of 8 g/dL).
Interpretation:
• minimum ABRI: a negative number
• maximum ABRI: > 100
• The typical ABRI for transfusion after bleeding is controlled is around 0.33. (A single unit of packed RBCs will raise the hemoglobin 1 g/dL in the absence of blood loss.)
• An ABRI >= 0.75 indicates that active bleeding is still occurring.
NOTE: A negative number (when initial hematocrit > final hematocrit) probably also indicates a failure to control hemorrhage.
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