Category: Clinical Obstetrics
Poster Session I
Postpartum anemia is a common condition that may necessitate transfusion of packed red blood cells (pRBC). Due to risks and costs associated with over-transfusion, there has been a debate among obstetricians regarding the amount of pRBCs administration: a single versus two-unit pRBC administration. In this study, we aimed to identify risk factors that may warrant transfusion of two units of pRBCs instead of a single unit.
Study Design: A retrospective, single-center cohort study of obtained cases between 2010 and 2020. We included women with postpartum anemia which required blood transfusion for hemoglobin levels below 7g/dL or ≥ 7g/dL if symptomatic after vaginal or cesarean delivery. Hemodynamically unstable women with systolic < 80 mmHg or diastolic < 40 mmHg blood pressures and heart rate > 130 beats per minute were excluded. Patients were allocated into one of two groups based on the amount of pRBCs transfusions received within 24 hours of birth, a single unit (group 1) versus two units (group 2).
Results: The final analysis included 368 women who received a single unit compared with 317 women receiving two units of pRBCs (Table 1). In univariate analysis, the duration of cesarean delivery (56.6 ± 35.8 vs. 45.5 ± 18.5 min, p=0.0063), episiotomy during vaginal delivery (45.1% vs. 30.7%, p=0.009), lowest postpartum mean hemoglobin levels (6.6 ± 0.6 g/dl vs. 6.9 ± 0.5 g/dl, p=0.0001) and mean delta of hemoglobin levels (4.3 ± 1.5 g/dl vs. 3.9± 1.5 g/dl, p=0.002) were significant risk factors for requiring two pRBCs compared to a single unit. Transfusion-related adverse effects were not affected by the total number of pRBCs given (Table 2). Despite our findings, in a multivariate analysis, none of the risk factors were significantly associated with the two-pRBCs protocol.
Conclusion:
Our study supports the practice of a single unit protocol in hemodynamically stable patients with postpartum anemia regardless of the presence of risk factors. Adjusting to these guidelines will help obstetricians reduce costs and morbidity associated with pRBCs transfusion.
Chen Ben David, MD
Rambam Health Care Campus
Haifa, Israel, Israel
Inbal Or, MS
Rambam health care campus
Haifa, Israel, Israel
Roee Iluz, MD
Rambam health care campus, Haifa, Israel
Haifa, Israel, Israel
Amir Weissman, MD
Rambam health care campus, Haifa, Israel
Haifa, Israel, Israel
Nizar Khatib, MD
Rambam Healthcare Campus
Acre, Hefa, Israel
Yuval Ginsberg, MD (he/him/his)
Deputy Ob/Gyn department
Rambam Medical Health Campus
Haifa, Israel
Ron Beloosesky, MD
Rambam Medical Health Campus
Haifa, Israel, Israel
Zeev Weiner, MD
Rambam Health Care Campus
Haifa, Israel, Israel
Ido Solt, MD
Director Maternal Fetal Medicine
Rambam Health Care Campus
Haifa, Israel
Dana Vitner, MD
Rambam Health Care Campus
Yaniv Zipori, MD
Rambam Healthcare Campus
Binyamina, HaZafon, Israel