Triggers and appropriateness of red blood cell transfusions in the postpartum patient–a retrospective audit

  1. C. So-Osman1,
  2. J. Cicilia2,
  3. A. Brand1,
  4. M. Schipperus3,
  5. B. Berning4,
  6. S. Scherjon2

Article first published online: 17 AUG 2009

DOI: 10.1111/j.1423-0410.2009.01231.x

Issue

Vox Sanguinis

Vox Sanguinis

Volume 98, Issue 1, pages 65–69, January 2010

Additional Information

How to Cite

So-Osman, C., Cicilia, J., Brand, A., Schipperus, M., Berning, B. and Scherjon, S. (2010), Triggers and appropriateness of red blood cell transfusions in the postpartum patient–a retrospective audit. Vox Sanguinis, 98: 65–69. doi: 10.1111/j.1423-0410.2009.01231.x

Author Information

  1. 1

    Department of Research and Development, Sanquin Bloodbank South West Region, Leiden, The Netherlands

  2. 2

    Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands

  3. 3

    Department of Haematology, HAGA Hospital, The Hague, The Netherlands

  4. 4

    Department of Obstetrics, HAGA Hospital, The Hague, The Netherlands

*Dr C. So-Osman, Sanquin Bloodbank South West Region, Plesmanlaan 1a, 2333 BZ Leiden, The Netherlands E-mail: C.So@sanquin.nl

Publication History

  1. Issue published online: 9 DEC 2009
  2. Article first published online: 17 AUG 2009
  3. Received: 16 March 2009, revised 8 July 2009, accepted 13 July 2009

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Keywords:

  • appropriateness;
  • fluxus postpartum;
  • obstetrics;
  • postpartum haemorrhage;
  • red blood cell transfusion

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.

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