The probability of survival was slightly higher with the restrictive strategy than with the liberal strategy in the subgroup of patients who had bleeding associated with a peptic ulcer (hazard ratio, 0.70; 95% CI, 0.26 to 1.25) and was significantly higher in the subgroup of patients with cirrhosis and Child–Pugh class A or B disease (hazard ratio, 0.30; 95% CI, 0.11 to 0.85), but not in those with cirrhosis and Child–Pugh class C disease (hazard ratio, 1.04; 95% CI, 0.45 to 2.37).Historically, patients who come in with massive GI bleeds due to ulcer disease are aggressively resuscitated with blood products and saline until they achieve hemodynamic stability (and if not, it's off to the OR). The decision to transfuse blood typically was a clinical decision, not one driven primarily by arbitrary hemoglobin counts.
The real life applicability of these findings is somewhat dubious. In an emergency situation, when a patient is hemodynamically labile in the ER and you aren't certain of the past medical history and blood is spewing out in torrents like the hallways in the Shining, it's tough to sit around and wait for the lab to run a CBC before deciding whether to thaw some blood or not.
From recent wartime experiences, we know from the trauma literature that outcomes are superior in those patients who are aggressively resuscitated with blood products early and often. It just doesn't make a whole lot of sense to delay treatment of a potentially exsanguinating patient based on an arbitrary laboratory result cut-off. Certainly, the game changes once a patient has stabilized. There's no reason to transfuse a HgB of 8.7 for the mere fact that 8.7 is less than 9.
I'll stick with the old standby of "clinical judgment", thank you very much.