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

Antenatal Anaemia and Postpartum Blood Transfusion (#17)

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

Background: Optimisation of antenatal haemoglobin (Hb) provides an opportunity to protect women who have postpartum haemorrhage (PPH) from a low postpartum Hb and subsequent red cell transfusion. Identification, and adequate treatment, of iron deplete women will assist in maximising peripartum Hb.

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. Anaemia was defined as Hb <=110 g/L during 1st and 3rd trimesters, Hb <=105g/L during 2nd trimester and immediate postpartum Hb <=100g/L. Only women with Hb taken immediately prior to delivery were included. Serum ferritin >30 µg/L is used to indicate adequate iron stores.

Results:  469 PPH occurred from 3235 delivery’s (14.5%). There were 434 cases of PPH where Hb was collected prior to delivery, with 99 receiving a red cell transfusion (23%).

Of the cases with PPH, 53 (12.2%) presented prior to delivery anaemic, mean Hb 103.2g/L. Subsequently 31 (58.5%) of these women received a transfusion, representing 31.3% of all transfusions. Non-anaemic women presented with a mean Hb 127.4g/L and only 17.8% required a transfusion. The odds ratio for transfusion was 6.4 (95% CI 3.9-10.8) in women with PPH who were anaemic prior to delivery compared with those who were not.

Those who presented anaemic, 11.3% were anaemic in the 1st Trimester and 26.4% in the 2nd Trimester

An isolated 1st/2nd Trimester Serum Ferritin was taken on 25 (47%) of the anaemic population.  Inadequate iron was recorded in only 14 (56%) of these women.

Conclusion: Anaemia prior to delivery significantly increased the risk of red cell transfusion. A missed opportunity to adequately identify and treat anaemia in the antenatal period may have increased the requirement of blood transfusions. Isolated Serum Ferritin did not always predict the risk of not developing anaemia in late pregnancy.    

  1. National Blood Authority (NBA) (2015). Patient Blood Management Guidelines: Module 5 – Obstetrics and Maternity. NBA, Canberra, Australia
  2. UK Guidelines on the Management of Iron Deficiency in Pregnancy. British Committee for Standards in Haematology. July 2011.
  3. Preoperative Anaemia Identification, Assessment and Management. National Blood Authority Australia. June 2014