International Journal of Obstetric Anesthesia
Volume 18, Issue 4 , Pages 302-308, October 2009

Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric center☆

  • A.J. Butwick
    • ,
  • P. Aleshi
    • ,
  • M. Fontaine

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr. Alexander Butwick, Department of Anesthesiology (MC: 5640), 300 Pasteur Drive, Stanford University School of Medicine, Stanford, California 94305, USA. Tel.: +1 650 736 8513; fax: +1 650 725 8544.
    • ,
  • E.T. Riley
    • ,
  • L.T. Goodnough

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr. Alexander Butwick, Department of Anesthesiology (MC: 5640), 300 Pasteur Drive, Stanford University School of Medicine, Stanford, California 94305, USA. Tel.: +1 650 736 8513; fax: +1 650 725 8544.

Departments of Anesthesiology and ∗Pathology, Stanford University School of Medicine, Stanford, California, USA

Accepted 3 February 2009. published online 23 July 2009.

Abstract 

Background

The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center.

Methods

A retrospective, observational study was performed of obstetric in-patients who received red blood cell transfusion and/or blood products over a one-year period. Data abstracted included transfusion data, pre-transfusion hemoglobin (Hb) and lowest recorded (nadir) Hb, and maternal and neonatal outcomes.

Results

During the study period, 74 patients received transfusion therapy (1.4%). Pre-transfusion and nadir Hb values were 7.6g/dL and 7.0g/dL respectively. Median [IQR] total red blood cells transfused were 2 units [2-3], with 41 (55%) patients receiving 1-2 units. Based on chart review, no specific indications for transfusion were identified in 25 patients (34%), and 13 patients (18%) had undetected postpartum anemia (Hb values <8.2g/dL) at least 24h after delivery.

Conclusion

More formal assessment and documentation of the etiologic factors associated with transfusion management in pregnant patients is advised. In addition, the identification and management of undetected postpartum anemia is underappreciated.

Keywords: Transfusion, Pregnancy, Anesthesia, Hemorrhage

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☆ This study was presented in part at the Society of Obstetric Anesthesia and Perinatology (SOAP) 40th Annual Meeting, April 2008, Chicago.

PII: S0959-289X(09)00040-5

doi:10.1016/j.ijoa.2009.02.005

International Journal of Obstetric Anesthesia
Volume 18, Issue 4 , Pages 302-308, October 2009

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