Triggers and appropriateness of red blood cell transfusions in the postpartum patientâa retrospective audit

So‐Osman, Cynthia; Cicilia, J.; Brand, Anneke; Schipperus, Martin R.; Berning, Britt A.; Scherjon, Sicco A.

doi:10.1111/j.1423-0410.2009.01231.x

Cited by 43 publications

(33 citation statements)

References 15 publications

(15 reference statements)

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“…The RCOG green top guidelines (RCOG, 2009) comprehensively cover the multidisciplinary approach required, together with the implementation of intra-operative cell salvage in this setting as a transfusion sparing strategy. However outside the massive haemorrhage setting, audits indicate that a high proportion of blood transfusions administered in the postpartum period may be inappropriate, with underutilization of iron supplements (Butwick et al, 2009;Parker et al, 2009;So-Osman et al, 2010).…”

Section: Indications For and Risks Of Blood Transfusionmentioning

confidence: 99%

UK guidelines on the management of iron deficiency in pregnancy

et al. 2012

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SummaryIron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally. Although it is particularly prevalent in less-developed countries, it remains a significant problem in the developed world, even where other forms of malnutrition have already been almost eliminated. Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion. The objective of this guideline is to provide healthcare professionals with clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period. This is the first such guideline in the UK and may be applicable to other developed countries. Public health measures, such as helminth control and iron fortification of foods, which can be important to developing countries, are not considered here. The guidance may not be appropriate to all patients and individual patient circumstances may dictate an alternative approach. Keywords: iron, iron depletion, iron deficiency, anaemia, pregnancy.The guideline group was selected by the British Society for Haematology, Obstetric Haematology Group (BSH OHG) and British Committee for Standards in Haematology (BCSH), to be representative of UK-based medical experts. MEDLINE and EMBASE were searched systematically for publications from 1966 until 2010 using the terms iron, anaemia, transfusion and pregnancy. Opinions were also sought from experienced obstetricians and practice development midwives. The writing group produced the draft guideline, which was subsequently considered by the members of the BSH Obstetric Haematology Group and revised by consensus by members of the General Haematology Task Force of the BCSH. The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the BSH Committee and comments incorporated where appropriate. Criteria used to quote levels of recommendation and grades of evidence are as outlined in the Procedure for Guidelines Commissioned by the BCSH. Summary of key recommendations• Anaemia is defined by Hb <110 g/l in the first trimester, <105 g/l in the second and third trimesters and <100 g/l in the postpartum period.• Full blood count (FBC) should be assessed at booking and at 28 weeks.• All women should be given dietary information to maximize iron intake and absorption.• Routine iron supplementation for all women in pregnancy is not recommended in the UK.• Unselected screening with routine use of serum ferritin is generally not recommended although individual centres with a particularly high prevalence of 'at risk' women may find this useful.• For anaemic women, a trial of oral iron should be considered as the first line diagnostic test, whereby an increment demonstrated at 2 weeks is a positive result.• Women with known haemoglobinopathy should have serum ferritin checked and offered oral supplements if their ferritin level is <30 lg/l. • Women with unknown haemoglobinopathy status with a normocyti...

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Section: Indications For and Risks Of Blood Transfusionmentioning

confidence: 99%

UK guidelines on the management of iron deficiency in pregnancy

et al. 2012

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“…Audits suggest that iron is underutilized and blood transfusions are administered inappropriately in the postpartum period. 80,81 Blood transfusion should be reserved for those with risk of further bleeding, imminent cardiac compromise, or symptoms requiring immediate attention. We give 100 mg of elemental iron for 3 months to women with Hb ,100 g/L in the postpartum period.…”

Section: Postpartum Managementmentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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Worldwide, ∼800 women die every day from preventable causes related to pregnancy or childbirth. The single most common cause is severe bleeding, which can kill a healthy woman within hours if care is substandard or delayed. Improved antenatal practices have led to the early identification of at-risk women and modern technology and new techniques have enabled effective management strategies so that now, in the western world, most of the morbidity and mortality arises from those cases which occur unexpectedly and could not have been predicted. Prompt and effective management and multidisciplinary involvement is paramount to save the lives of these women. We use a case report to illustrate and discuss the main elements of management of this condition.

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“…4 Yet, despite this, it has been suggested that obstetric patients are unnecessarily exposed to blood products because of the lack of clear indications for blood transfusion. [5][6][7][8] As there are limited data on the risk factors associated with RBCT, that is, what obstetric subpopulations are being transfused, as well as trends for RBCT for these patients, ascertaining this information can aid in identifying patient groups who may benefit from alternatives to RBCT ultimately reducing maternal and fetal risks of exposure to RBCT. 9 Indeed, identifying and reporting trends in RBCT also assists in prioritizing research initiatives and predicting demand.…”

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confidence: 99%

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

et al. 2017

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Triggers and appropriateness of red blood cell transfusions in the postpartum patientâa retrospective audit

Abstract: 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.

Cited by 43 publications

References 15 publications

UK guidelines on the management of iron deficiency in pregnancy

UK guidelines on the management of iron deficiency in pregnancy

How I treat postpartum hemorrhage

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

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Triggers and appropriateness of red blood cell transfusions in the postpartum patientâa retrospective audit

Abstract: 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.

Cited by 43 publications

References 15 publications

UK guidelines on the management of iron deficiency in pregnancy

UK guidelines on the management of iron deficiency in pregnancy

How I treat postpartum hemorrhage

Risks and trends of red blood cell transfusion in obstetric patients: a retrospective study of 45,213 deliveries using administrative data

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Triggers and appropriateness of red blood cell transfusions in the postpartum patientâa retrospective audit