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Triggers and appropriateness of red blood cell transfusions in the postpartum patient–a retrospective audit
Author(s) -
SoOsman C.,
Cicilia J.,
Brand A.,
Schipperus M.,
Berning B.,
Scherjon S.
Publication year - 2010
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/j.1423-0410.2009.01231.x
Subject(s) - medicine , retrospective cohort study , observational study , blood transfusion , audit , population , red blood cell , emergency medicine , transfusion medicine , pediatrics , obstetrics , pregnancy , management , environmental health , economics , biology , genetics
Background and Objective Despite published guidelines, a proportion of red blood cell (RBC) transfusions seem unnecessary. To evaluate the indications for and the appropriateness of RBC transfusions in the postpartum patient, we performed a retrospective audit over a 1‐year period in two Dutch hospitals. Study Design and Methods Observational study of transfused obstetric patients, admitted in 2006 to the Departments of Obstetrics of a university and a general hospital, was carried out. Relevant clinical and laboratory data were recorded. The appropriateness of RBC transfusions was assessed using the national and age‐based transfusion guidelines for the general population; for the studied group the transfusion threshold haemoglobin (Hb) value was 6·4 g/dl for non‐massive and 8·1 g/dl for massive blood loss. From these we derived target Hb levels. Results Ninety patients received one or more RBC units within 48 h of delivery. Mean pretransfusion Hb level was 6·9 [SD 1·2] g/dl. Median number of transfusions was 2. Mean Hb level at discharge was 9·7 [SD 1·1] g/dl. Taking threshold Hb and the derived target Hb level into account, 68% ( n = 61) of the patients may have received one or more RBC units inappropriately. Of 311 RBC units transfused, 143 units (46%) were possibly inappropriate, partly due to over‐transfusion. Conclusion A significant proportion of postpartum RBC transfusions are possibly inappropriate, partly due to over‐transfusion. If current guidelines would be more specific, in particular, with respect to the target Hb levels, the total amount of RBC transfusions may be considerably decreased.