Triggers and appropriateness of red blood cell transfusions in the postpartum patient–a retrospective audit
Article first published online: 17 AUG 2009
© 2009 The Author(s). Journal compilation © 2009 International Society of Blood Transfusion
Volume 98, Issue 1, pages 65–69, January 2010
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
- Issue published online: 9 DEC 2009
- Article first published online: 17 AUG 2009
- Received: 16 March 2009, revised 8 July 2009, accepted 13 July 2009
- fluxus postpartum;
- 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.