Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

Abstract

BACKGROUND Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS A cross‐sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one‐half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre‐ and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.

The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a systematic review and meta-analysis

“…Risk factors for anaemia other than iron deficiency should be considered, including the social determinants of health which predispose to common infections such as HIV and AIDS, TB and parasitic infestations, as well as obesity [ 3 ]. In the studies conducted in HIV positive cohorts, a positive association between anaemia and the condition was seen [ 5 , 18 – 20 , 31 , 18 , 34 , 35 , 37 , 41 , 44 , 47 , 51 ]. Globally, there is an increase in the prevalence of anaemia in HIV-positive patients and those with AIDS, possibly due to increased blood loss from concomitant neoplasia or gastrointestinal lesions, or due to decreased red blood cell (RBC) production, RBC destruction or inefficient RBC production.…”

A review of recent advancements in Actinium‐225 labeled compounds and biomolecules for therapeutic purposes

“…DOTA conjugates with antibodies and peptides such as hum195, j591, B4, TADOTAGA, PSMA‐617, PSMA I&T, and Crown‐αMSH are directly labeled with Ac‐225 (Abbasi et al, 2021; Maguire et al, 2014; Yang et al, 2020). X‐ray fine absorption studies have shown that the macrocyclic chelating agents like HEHA and HEHA‐NCS were also initially conjugated with targeting vector monoclonal 201B antibody and then labeled with Ac‐225 which were investigated for lungs cancer treatment (Bloch et al, 2020). Ac‐225 easily form complex with acyclic chelating agents such as EDTA and CHX‐A‐DTPA that showed very fast radiolabeling at room temperature in a very short time for in vivo therapy of liver cancer treatment (Boros & Holland, 2018; Foss et al, 2005).…”