Triggers and appropriateness of red blood cell transfusions in the postpartum patient--a retrospective audit.
OBJECTIVE
Despite published guidelines, a proportion of red blood cell (RBC) transfusions seem unnecessary. To evaluate the indications for and the appropriateness of RBC transfusions in the postpartum patient, we performed a retrospective audit over a 1-year period in two Dutch hospitals.


METHODS
Observational study of transfused obstetric patients, admitted in 2006 to the Departments of Obstetrics of a university and a general hospital, was carried out. Relevant clinical and laboratory data were recorded. The appropriateness of RBC transfusions was assessed using the national and age-based transfusion guidelines for the general population; for the studied group the transfusion threshold haemoglobin (Hb) value was 6.4 g/dl for non-massive and 8.1 g/dl for massive blood loss. From these we derived target Hb levels.


RESULTS
Ninety patients received one or more RBC units within 48 h of delivery. Mean pretransfusion Hb level was 6.9 [SD 1.2] g/dl. Median number of transfusions was 2. Mean Hb level at discharge was 9.7 [SD 1.1] g/dl. Taking threshold Hb and the derived target Hb level into account, 68% (n = 61) of the patients may have received one or more RBC units inappropriately. Of 311 RBC units transfused, 143 units (46%) were possibly inappropriate, partly due to over-transfusion.


CONCLUSIONS
A significant proportion of postpartum RBC transfusions are possibly inappropriate, partly due to over-transfusion. If current guidelines would be more specific, in particular, with respect to the target Hb levels, the total amount of RBC transfusions may be considerably decreased.
So-Osman
C
C
Department of Research and Development, Sanquin Bloodbank South West Region, Leiden, The Netherlands. c.so@sanquin.nl
Cicilia
J
J
Brand
A
A
Schipperus
M
M
Berning
B
B
Scherjon
S
S
D000328:Adult; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D049590:Postpartum Period; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D019564:Unnecessary Procedures
D006454:Hemoglobins