Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Postpartum Obstetric Blood Transfusion Management (#22)

Ben Stephens 1 , Philip Crispin 2 3 , Ken Tan 4 , Farah Sethna 1
  1. Obstetric and Gynaecology, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia
  2. Australian National University Medical School, Acton, Australian Capital Territory, Australia
  3. Haematology Department, The Canberra Hospital, Garran, Australian Capital Territory, Australia
  4. Obstetrics and Gynaecology, Calvary Health Care, Bruce, Australian Capital Territory, Australia

Background: Australian Guidelines for transfusion have been updated to develop a holistic approach to the management of blood as a system, rather than focus on salvage therapy with transfusion alone.  Concurrent with the release of the National Blood Authority Module 5 Obstetrics and Maternity Patient Blood Management Guideline (2015) we conducted an audit to determine potential areas for improvement in transfusion for postpartum haemorrhage (PPH).

Methods: A retrospective audit of PPH and associated red cell transfusion was conducted at a tertiary level obstetrics unit from January 1st 2013 to December 31st 2013. Relevant clinical and laboratory data was collected for all PPH and associated red cell transfusions. Transfusion were considered appropriate with a pre-transfusion haemoglobin (Hb) =<70, post transfusion Hb =< 90 or with active bleeding during severe haemorrhage.

Results:  There were 469 cases of PPH from 3235 deliveries (14.5%). Resulting in 110 patients requiring red cell transfusion (3.4%).  56 transfusions (51%), with a mean pre-transfusion Hb of 68g/L, were considered appropriate. Additionally, 53 transfusions (48.2%), with a mean post transfusion Hb of 83g/L, were additionally appropriate. Anaesthetists used a correct pre-transfusion trigger 83% of the time and Obstetric Residents 32%. However,   obstetric residents achieved an appropriate post transfusion Hb 52% of the time compared with 45% for anaesthetics. Overall 24% of transfused patients had a post transfusion Hb => 100g/L.

Based on each decision to transfuse, 14%  involved 1 unit of blood with 73.3% having an appropriate post transfusion Hb (mean 79g/L). 71% received 2 units, 50% achieving an appropriate post transfusion Hb (mean 84g/L). 7% received 3 units, only 12.5% deemed appropriate with mean post transfusion Hb 86g/L and 8% >3 units. Only 4 parenteral iron infusions were used.

Conclusion: A significant number of red cell transfusions appeared outside recommended guidelines. Identified areas for improvement include increasing the rate of single unit transfusion decisions, consideration of intravenous iron and consideration of appropriate transfusion triggers.   

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