Asian Journal of Transfusion Science
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LETTER TO THE EDITOR Table of Contents   
Year : 2019  |  Volume : 13  |  Issue : 2  |  Page : 151-152
Transfusion practice in obstetrics – Indian scenario


1 Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala, India
2 AS Raja Voluntary Blood Bank, Vishakhapatnam, Andhra Pradesh, India
3 Department of Transfusion Medicine, Chettinad Hospital, Chennai, Tamil Nadu, India

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Date of Web Publication3-Dec-2019
 

How to cite this article:
Murugesan M, Doshi K, Subbiah S P. Transfusion practice in obstetrics – Indian scenario. Asian J Transfus Sci 2019;13:151-2

How to cite this URL:
Murugesan M, Doshi K, Subbiah S P. Transfusion practice in obstetrics – Indian scenario. Asian J Transfus Sci [serial online] 2019 [cited 2019 Dec 13];13:151-2. Available from: http://www.ajts.org/text.asp?2019/13/2/151/272052




Sir,

Obstetric hemorrhage as per the standard definitions of postpartum hemorrhage that is 500 mL for vaginal and 1000 mL for cesarean (C/S) deliveries is usually well tolerated by nonanemic women.[1],[2] On the contrary, massive obstetric hemorrhage is often sudden and account for 25% of deaths among women worldwide and accounts 1%–4% among the obstetric population.[3],[4]

The era of the 1980s was plagued with the fear of HIV transmission by blood transfusions, which bred the notion of single-unit transfusions being wasteful. This was owing to the episodic risk attributed to transfusions. Concepts surrounding transfusions are changing at its core, especially toward minimizing transfusions firstly because blood is a finite resource and secondly because a dose-response pattern has been established to each unit of blood transfused.

With this background, we conducted a prospective 1-year audit on 17,275 obstetric admissions in a tertiary care teaching hospital, of which requests for transfusion were received for 21.2%. Pretransfusion crossmatch requests were received either as a “cover” (70.1% of requests) for labor and C/S or for other specific diagnoses (20.9% of requests) such as abruptio and ectopic pregnancy rupture uterus. Data revealed only 2% cases under “cover” received transfusions, whereas 60.1% cases with other diagnoses were transfused.

Complying with recommendations, only 3.5% of patients transfused had hemoglobin (Hb) >10 g% and 44% of patients transfused had Hb <6 g%.

Single-unit transfusion was the most common in 62% of patients, followed by two units in 23% of patients. Over one-half of patients who received transfusions were in the ambiguous category of 6–10 g%, among whom 57.8% received single-unit transfusions. These numbers imply that Hb levels were not the main determinant for guiding transfusion.

Several variables influence transfusion decisions in addition to Hb levels, which may be explored as viable strategies to reduce transfusions, especially because of the direct and indirect costs incurred for every transfusion. The WHO (2002) recommends minimizing the practice of single-unit transfusions as and when possible[5]. And BCSH (2001) suggested two units of red cells should be transfused in adults if patient is otherwise stable, and then, the clinical situation and Hb concentration should be reassessed[6]. However, the recently recommended practice of transfusing single-unit red blood cell for nonbleeding hospitalized patients, followed by the clinical reassessment to determine the need for transfusion was considered appropriate, and this reassessment will also guide the decision on whether to retest the Hb levels[7].

Strategies for behavior modification in areas where two units are requested merely based on pretransfusion Hb or habitually following earlier recommendations may be targeted to ultimately make judicious use of blood components. This area may be taken up for randomized control trials with robust study designs where patient baseline clinical condition and patient outcome are monitored in control and test groups not receiving and receiving transfusions, respectively.

To conclude, we feel that single-unit transfusion decisions are safe in stable hospitalized obstetric patients, and the decision to transfuse subsequent units should be prescribed only after reassessment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Newton M, Mosey LM, Egli GE, Gifford WB, Hull CT. Blood loss during and immediately after delivery. Obstet Gynecol 1961;17:9-18.  Back to cited text no. 1
    
2.
Goundan A, Kalra JK, Raveendran A, Bagga R, Aggarwal N. Descriptive study of blood transfusion practices in women undergoing cesarean delivery. J Obstet Gynaecol Res 2011;37:1277-82.  Back to cited text no. 2
    
3.
Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: A nationwide population-based study of 371,000 pregnancies. BJOG 2008;115:842-50.  Back to cited text no. 3
    
4.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG 2008;115:1265-72.  Back to cited text no. 4
    
5.
Principles of Clinical Transfusion Practice. Blood Transfusion Safety. The Clinical Use of Blood, Handbook. Geneva: World Health Organization; 2002. p. 7-8.  Back to cited text no. 5
    
6.
Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, et al. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001;113:24-31.  Back to cited text no. 6
    
7.
Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red blood cell transfusion: A clinical practice guideline from the AABB. Ann Intern Med 2012;157:49-58.  Back to cited text no. 7
    

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Correspondence Address:
Mohandoss Murugesan
Department of Transfusion Medicine, Malabar Cancer Centre, Thalassery, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajts.AJTS_161_18

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006