A retrospective analysis of postpartum red blood cell transfusions at a tertiary care obstetric centre.

IF 1.8 4区医学 Q3 HEMATOLOGY Vox Sanguinis Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI:10.1111/vox.13702

Ariane Lasry, Samuel Adant, Karen Farag, Celya Tidafi, Cassandra Wareham, Mandy Malick, Marie-Ève Roy-Lacroix, Pierre-Aurèle Morin, Nadine Sauvé

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Abstract

Background and objectives: Postpartum anaemia is a prevalent health problem. We aimed to determine the compliance rate for red blood cell (RBC) transfusion indication among postpartum women in a single tertiary care centre in Quebec, Canada.

Materials and methods: Retrospective cohort study including all women ≥6 h postpartum who received ≥1 RBC transfusion during their delivery hospitalization between January 2005 and February 2022. We determined our centre's compliance rate by indication as compared to current society guidelines, all published after 2015 (Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis [NATA], Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG]). We then explored predictors of guideline non-compliance and described transfusion practices in our centre.

Results: A total of 171 women were included. Our centre's compliance rate was 79.5% (95% confidence interval [CI] 72.7-84.8). Predictors of guideline non-compliance were maternal medical comorbidity or abnormal placentation, both limited by large CIs (odds ratio [OR] 2.26, CI 1.02-4.94, p = 0.04; OR 4.00, CI 1.31-12.06, p = 0.01, respectively). Postpartum haemorrhage was diagnosed among 68% of the cohort, mostly due to uterine atony (73.3%). Mean baseline and nadir haemoglobin were 111 g/L (±18) and 62 g/L (±7.7), respectively. Multiple unit initial transfusion was found in a majority of patients (63.7%). Iron therapy was administered to 51.5% of women in-hospital and 81.9% received an oral iron prescription at discharge. There were no differences in primary or secondary outcomes subsequent to relevant guideline publication.

Conclusion: Our centre's compliance rate for RBC transfusion indication meets current practice guidelines. Areas for improvement include single-unit initial transfusion protocols and adjuvant iron treatment. Antenatal optimization of haemoglobin and ferritin stores may limit postpartum transfusions.

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对一家三级产科护理中心产后输红细胞情况的回顾性分析。

背景和目的：产后贫血是一个普遍存在的健康问题。我们旨在确定加拿大魁北克省一家三级医疗中心的产后妇女对红细胞（RBC）输注指征的依从率：回顾性队列研究，包括 2005 年 1 月至 2022 年 2 月期间所有产后≥6 小时、在分娩住院期间接受过≥1 次 RBC 输血的产妇。我们按照适应症确定了本中心的合规率，并与当前的学会指南进行了比较，这些指南都是在 2015 年之后发布的（促进患者血液管理、止血和血栓形成网络 [NATA]、英国皇家妇产科医师学会 [RCOG]、美国妇产科医师学会 [ACOG]）。然后，我们探讨了不遵守指南的预测因素，并介绍了我们中心的输血做法：结果：共纳入 171 名产妇。我们中心的符合率为 79.5%（95% 置信区间 [CI] 72.7-84.8）。产妇合并症或胎盘异常是不遵守指南的预测因素，两者均受较大的 CIs 限制（几率比 [OR] 分别为 2.26，CI 1.02-4.94，p = 0.04；OR 4.00，CI 1.31-12.06，p = 0.01）。68%的患者确诊为产后出血，主要是由于子宫失弛缓（73.3%）。平均基线血红蛋白为 111 克/升（±18），最低血红蛋白为 62 克/升（±7.7）。大多数患者（63.7%）的初始输血量为多个单位。51.5%的妇女在院内接受了铁剂治疗，81.9%的妇女在出院时获得了口服铁剂处方。相关指南发布后，主要或次要结果没有差异：结论：我们中心的红细胞输注适应症达标率符合当前的实践指南。需要改进的方面包括单单位初始输血方案和辅助铁剂治疗。产前优化血红蛋白和铁蛋白储存可限制产后输血。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vox Sanguinis 医学-血液学

CiteScore

4.40

自引率

11.10%

发文量

156

审稿时长

6-12 weeks

期刊介绍： Vox Sanguinis reports on important, novel developments in transfusion medicine. Original papers, reviews and international fora are published on all aspects of blood transfusion and tissue transplantation, comprising five main sections: 1) Transfusion - Transmitted Disease and its Prevention: Identification and epidemiology of infectious agents transmissible by blood; Bacterial contamination of blood components; Donor recruitment and selection methods; Pathogen inactivation. 2) Blood Component Collection and Production: Blood collection methods and devices (including apheresis); Plasma fractionation techniques and plasma derivatives; Preparation of labile blood components; Inventory management; Hematopoietic progenitor cell collection and storage; Collection and storage of tissues; Quality management and good manufacturing practice; Automation and information technology. 3) Transfusion Medicine and New Therapies: Transfusion thresholds and audits; Haemovigilance; Clinical trials regarding appropriate haemotherapy; Non-infectious adverse affects of transfusion; Therapeutic apheresis; Support of transplant patients; Gene therapy and immunotherapy. 4) Immunohaematology and Immunogenetics: Autoimmunity in haematology; Alloimmunity of blood; Pre-transfusion testing; Immunodiagnostics; Immunobiology; Complement in immunohaematology; Blood typing reagents; Genetic markers of blood cells and serum proteins: polymorphisms and function; Genetic markers and disease; Parentage testing and forensic immunohaematology. 5) Cellular Therapy: Cell-based therapies; Stem cell sources; Stem cell processing and storage; Stem cell products; Stem cell plasticity; Regenerative medicine with cells; Cellular immunotherapy; Molecular therapy; Gene therapy.