|Year : 2018 | Volume
| Issue : 2 | Page : 116-120
Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study
Deshpande Madhushree, Mrityunjay C Metgud, Kamal Patil
Department of Obstetrics and Gynaecology, JNMC, Belgaum, Karnataka, India
|Date of Web Publication||18-May-2018|
Dr. Mrityunjay C Metgud
Department of Obstetrics and Gynaecology, JNMC, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
OBJECTIVES: This study was conducted to know the various indications of blood transfusion (blood and blood products) in obstetrics and to know transfusion reactions if any.
METHODOLOGY: This study was done from September 2014 to September 2015 in the Department of Obstetrics and Gynaecology, KLE Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi. All women who received blood and blood product transfusion for any obstetric cause during this period were analyzed to know the indications for transfusion and to know transfusion reactions.
RESULTS: A total of 204 women received blood and blood products transfusion in this study. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, hemolysis, elevation of liver enzymes and low platelets, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, ruptured uterus, and others (incomplete abortion, complete abortion, hydatidiform mole, and persistent trophoblastic disease). Anemia in pregnancy was the most common indication and was observed in 121 cases (58.45%) followed by Obstetric hemorrhage, which was seen in 40 cases (19.32%). The incidence of transfusion reactions was 4.41% in our study.
CONCLUSION: A proper knowledge for blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. The appropriateness of utilization of blood and blood products lies with the physicians' compliance with blood transfusion guidelines. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion. Measures to prevent anemia should be implemented. Obstetric hemorrhage is an emergency situation and cannot always be avoided or prevented. The development of various strategies to avoid transfusion reactions is needed.
Keywords: Blood transfusion, indications, transfusion reactions
|How to cite this article:|
Madhushree D, Metgud MC, Patil K. Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study. Indian J Health Sci Biomed Res 2018;11:116-20
|How to cite this URL:|
Madhushree D, Metgud MC, Patil K. Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Dec 19];11:116-20. Available from: http://www.ijournalhs.org/text.asp?2018/11/2/116/232686
| Introduction|| |
Pregnancy poses a special challenge as immune responses in pregnant and nonpregnant states are different. In the Developing country, obstetric complications are the leading indications for blood transfusion. Blood transfusion is considered as one of the eight essential components of comprehensive emergency obstetric care, which has been shown to reduce the maternal mortality rates. Blood and blood products are a limited resource, and therefore an effective use of the same is of utmost importance. An irrational use of blood leads to the wastage of precious medical resources and in addition, leads to an increase in the blood transfusion risk, eventually, increasing the economic burden. Hence, it is very important to look into the rationality of clinical blood transfusion and management of the same. Clinical audits are of great help to understand and analyze the rationality of blood transfusions. One common indication for blood transfusion in women is severe anemia; the prevalence of which is highest in India, with half of the global maternal deaths due to anemia.
In the world, obstetric hemorrhage is the most common cause of maternal death, causing 24% of, or an estimated 127,000 maternal deaths annually. Hemorrhage continues to be the leading cause of maternal mortality worldwide, accounting for 31% in Asia and 13% in developed countries. Emphasis should be put on the management of the third stage of labor so as to prevent avoidable morbidities such as postpartum hemorrhage (PPH), retained products of conception, and vaginal lacerations. Access to compatible and properly processed blood is crucial in emergency obstetric care and to reduce maternal mortality.
It has been observed that injudicious use of blood and blood products can lead to a number of complications in the recipients. The use of blood transfusions must be limited to an essential as it still causes a number of complications which are not negligible. Hemolytic reactions can occur as a serious complication of incompatible blood transfusion. Delayed hemolytic reactions can occur after a seemingly compatible blood transfusion.
| Methodology|| |
This was retrospective cross-sectional study.
A total of 204 pregnant and delivered women who received blood and blood product transfusion for an obstetric cause.
All patients who have received blood transfusion for any obstetric cause from September 2014 to September 2015.
| Results|| |
A total of 204 women received blood and blood product transfusion for an obstetric cause.
About 78.92% (161) women received blood transfusions antenatally, 13.72% (28) women received blood transfusions intranatally, and 7.35% (15) women received blood transfusion postnatally [Table 1].
In total, 66 (32.35%) of the women were registered at our institute, 75 (36.76%) were registered outside, and 63 (30.88%) were unregistered [Table 2].
Totally, 31 (15.19%) of the women were severely anemic, 154 (75.49%) were moderately anemic, 9 (4.41%) were having mildly anemic, and 10 (4.90%) did not have anemia as per the hemoglobin (Hb) level [Table 3].
At the time of admission, 8 (3.92%) of the patients had hypotension, 15 (7.35%) had hypertension, and 181 (88.73%) had normal blood pressure [Table 4].
The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, hemolysis, elevation of liver enzymes and low platelets (HELLP), thrombocytopenia, disseminated intravascular coagulopathy (DIC), ruptured ectopic, ruptured uterus, and others (incomplete abortion, complete abortion, hyadatidiform mole, and persistent trophoblastic disease) [Table 5].
The number of indications listed in [Table 5] shows a total of 207, while the actual numbers of recipients are 204. This is because three patients received blood for >1 indication and so had to be included in all of those categories. These patients are the ones who received blood/blood product transfusion for anemia with DIC, abruption with DIC, and HELLP with DIC.
Out of the 121 patients who received blood transfusion for anemia as an indication, 114 received it for antenatal anemia only, 6 had anemia along with thrombocytopenia, and 1 had anemia along with thrombocytopenia and DIC [Table 6].
Eight patients received transfusion because of thrombocytopenia only.
One patient received transfusion due to ruptured uterus.
DIC was observed in three patients but was not solely an indication for transfusion. It was seen in cases of anemia with thrombocytopenia, abruption with thrombocytopenia and HELLP.
Out of the 40 patients, who received blood for obstetric hemorrhage as an indication, 14 patients were transfused blood solely because of abruption, 6 patients received transfusion for abruption along with thrombocytopenia, and 1 patient received transfusion for abruption with thrombocytopenia with DIC. Six patients received blood transfusion because of placenta previa out of which 5 patients were because of placenta previa solely while 1 patient was a case of placenta previa with thrombocytopenia. Seven patients were transfused blood for atonic PPH, 4 received for traumatic PPH while 2 for secondary PPH [Table 7].
Blood and blood product transfusion was needed for ruptured ectopic in 10 patients. Out of these, eight patients solely needed it for ruptured ectopic pregnancy while two needed it for ruptured ectopic along with thrombocytopenia [Table 8].
HELLP was an indication in a total of 3 cases but was present as an indication along with DIC in 1 of these 3 cases [Table 9].
Twenty-one patients received transfusion for indications other than the aforementioned indications. The others included indications such as incomplete abortion, complete abortion, hyadatidiform mole, and persistent trophoblastic disease [Table 10].
In our study, 180 (88.23%) women received packed cells, 26 (12.74%) received whole blood, 29 (14.21%) received random donor platelets, 28 (13.72%) received fresh frozen plasma, 9 (4.41%) received cryoprecipitate, and only 1 (0.49%) received single donor platelets as blood transfusion [Table 11].
The number of units of blood transfused is more than the number of patients because many patients received a combination of blood products. In our study, 110 patients received single unit transfusion while the remaining 94 received multiple transfusions; thus, increasing the number of units transfused.
In the present study, 9 out of 204 women (4.41%) had a transfusion reaction while 95.59% had none. Three out of these 9 women had a major transfusion reaction in the form of transfusion-related acute lung injury while the remaining 6 had minor transfusion reactions such as Urticarial rash and Chills [Table 12].
| Conclusion and Summary|| |
Although World Blood Donor Day is acknowledged on June 14 every year, blood still remains scarce in many parts of the world. This scarcity very often has deadly consequences for women and children.
A proper knowledge for blood and blood product transfusion is needed to avoid irrational use of the blood and blood products and thus making it available for people who are actually in need and also to decrease the economic burden. The appropriateness of utilization of blood and blood products lies with the physicians' compliance with blood transfusion guidelines, implementation of relevant regulations and timely audits of blood transfusion. A pretransfusion approval program should be implemented as a guide to pretransfusion evaluation.
The Hb trigger for giving blood transfusion in pregnancy is <7 gm/dl. Anemia still persists to be a major cause for blood and blood product transfusion. Measures to prevent anemia such as early antenatal bookings, iron supplementation, and evaluation of Hb levels should be implemented to avoid unnecessary blood transfusions and also to bring down the rate of blood transfusion.
A reanalysis of our antenatal training program and a focus on correction of already anemic women by supplementing oral or parentral iron is needed.
Detection of high-risk pregnancies such as grand multiparas, preeclampsia, and multiple pregnancies should be done meticulously. The rate and amount of transfusion can be brought down if these high-risk pregnancies are properly followed up, timely managed and are encouraged for a hospital delivery. Preventive measures aimed at reducing PPH by treating anemia and infectious diseases are often insufficient to decrease the incidence of obstetric hemorrhage. Active management of the third stage of labor should be implemented strictly. Obstetric hemorrhage is an emergency situation and cannot always be predicted or avoided. Thus, a well-functioning blood bank is very essential to provide blood and blood products in the time of such emergencies.
Packed red blood cells should be used in obstetric emergencies rather than whole blood for transfusion as whole blood leads to increased plasma volume, thus causing circulatory overload.
Development of various strategies to avoid transfusion reactions is needed.
Blood transfusion, though a lifesaving process, still poses a vital threat of transfusion reactions and various other transfusion-related morbidities. Leukocyte depleted components should be recommended for use. Education of staff and awareness about reporting the transfusion reactions is the key step in improving the safety of blood transfusions and preventing transfusion reactions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schantz-Dunn J, Nour NM. The use of blood in obstetrics and gynecology in the developing world. Rev Obstet Gynecol 2011;4:86-91.
Singh S, Sinha P, Yadav G, Gupta U, Tyagi P. Transfusion practices in obstetrics and gynaecology in a tertiary care center. Int J Reprod Contracep Obstet Gynecol 2016;5:831-4.
Zhu C, Gao Y, Li Z, Li Q, Gao Z, Liao Y, et al
. A systematic review and meta-analysis of the clinical appropriateness of blood transfusion in China. Medicine (Baltimore) 2015;94:e2164.
Agrawal VP, Akhtar M, Mahore SD. A retrospective clinical audit of blood transfusion requests in tertiary care hospital. IJBAR 2013:04:657-60.
Chhabra S, Namgyal A. Rationale use of blood and its components in obstetric-gynecological practice. J Mahatma Gandhi Inst Med Sci 2014;2:93-9.
Matsunaga S, Seki H, Ono Y, Matsumura H, Murayama Y, Takai Y, et al
. A retrospective analysis of transfusion management for obstetric hemorrhage in a Japanese obstetric center. ISRN Obstet Gynecol 2012;2012:854064.
Ouédraogo CM, Ouédraogo A, Kaboré RA, Gondo D, Koné D, Natacha B, et al
. Analysis of blood transfusion requirements during the gravid-puerperal period in a hospital in Ouagadougou. Field Actions Sci Rep 2012;5:1-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]