- Hemodynamic instability (tachycardia or prolonged capillary refill time, with or without hypotension) or generally unwell appearance
- Melena or large hematochezia
- Large-volume hematemesis or nasogastric aspirates (this can be very difficult to estimate due to dilution)
- Known or suspected esophageal varices (eg, known liver disease or splenomegaly) or intestinal surgery
- Significant anemia (ie, hemoglobin >20% below lower limit for age, decrease of >20% from a recent value, or need for transfusion)
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