[CG] Postpartum Blood Transfusion in Stable Patients

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Objectives

To develop a policy of prescription of blood transfusion based on symptoms and signs rather than based on haemoglobin value. To minimize the number of units transfused without comprising the benefits of transfusion.

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Blood transfusion though life saving is not without hazards. The risk of complications (immunologic, non immunologic) increases with the volume of transfusion. It is important to avoid unnecessary exposure to allogenic blood products. Due to safety concerns, many recent studies on restrictive transfusion policy have been published and they have been shown to be effective.2,3,4 Moreover the number of red cell units ordered are not always utilised and can lead to significant wastage.1

Evaluation for transfusion in post natal ward

  • Haemodynamically stable
  • No evidence of ongoing haemorrhage, underlying medical disorder
  • Symptoms and signs of anaemia(palpitations, fatigue, fainting spells, shortness of breath, pale skin)
  • Haemoglobin value

Management

Haemoglobin
≥ 90g/l
Haemoglobin
70 - 89g/l
Haemoglobin
<70g/l
Iron therapy Evaluate signs & symptoms Evaluate signs & symptoms
  Asymptomatic - alternative therapy Discuss with senior
  Symptomatic – prescribe single unit Symptomatic – transfuse as
indicated
  Re evaluate after single transfusion Single/multiple units
  Still symptomatic – discuss with Senior
regarding further transfusion
Alternative therapy
  • Discuss the potential risks and benefits of blood transfusion with the patient and clearly document in the case notes.
  • Fully complete the Blood Component Prescription and Record of Transfusion form.
  • Alternative therapy – oral iron therapy, parenteral iron therapy
  • Seniors - Registrar, Consultant
  • Patient declining transfusion- Discuss with Seniors
References

Retrospective study of postnatal ward blood transfusion in the Southern General hospital 2010

Postpartum Blood Transfusion. Maternity Services Lothian guidelines, Departmental audit.

Ma M, Eckert K, Ralley F, Chin- Yee I. A retrospective study evaluating single – unit red blood cell transfusions in reducing allogenic blood exposure. Transfuse Med 2005; 15(4): 307-312

Naylor JM, Adie S, Fransen M, Dietsch S, Harris,I. Endorsing single – unit transfusion combined with a restrictive haemoglobin, transfusion threshold after knee arthroplasty. Qual Sa Health Care BmJ 2010; 239- 243

UK Blood transfusion and Tissue transplantation guidelines

Last reviewed: 07 February 2019

Next review: 31 January 2022

Author(s): Dr R Rajagopal & Dr J Roberts, Consultant Obstetrician SGH on behalf of GONEC; E.Harrison, Transfusion Practitioner.

Version: 2

Document Id: 325