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The Management of Bleeding Esophageal Varices

William M. Palko, MD
JAMA. 1987;257(1):30. doi:10.1001/jama.1987.03390010033021.
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To the Editor.—  In the Sept 19 issue of JAMA, Cello et al1 make the unreferenced statement that "relatively fresh whole blood (less than three days old)" should be used for volume resuscitation in patients with bleeding esophageal varices. Why do they set this three-day limit? Moreover, it is not clear from the article if the three-day limit applied to whole blood also exists for red blood cells. The main goal in treatment of patients who are bleeding is to restore blood volume and increase the red blood cell mass for oxygen transport. That goal can be achieved by whole blood of any age, or the use of red blood cells of any age combined with crystalloid or colloid.2 Blood is seldom available for transfusion until it is at least 36 to 48 hours' old because of the extensive testing required (including screening for transmissible disease such as


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