J Parker1, J Thompson, S Stanworth. 1. Department of Obstetric Anaesthesia, Women's Centre, John Radcliffe Hospital, Oxford, UK. jacquismail@gmail.com
Abstract
BACKGROUND: Fears about safety and availability of blood in the United Kingdom have prompted efforts to encourage evidence-based blood transfusion in all areas of medicine, with increasing interest in the obstetric population. A retrospective one-year single-centre audit of obstetric red cell transfusions was conducted. METHODS: Study subjects were those given a red cell transfusion during their perinatal care between April 2006 and March 2007 inclusive. A pre-piloted data collection pro forma was used to collect information from maternity case notes on demographics, location of transfusion, ordering physician, reason for transfusion, counselling, consent, and related laboratory data. RESULTS: Two-hundred and two women were transfused during their perinatal care (30.8 per 1000 cases), 49% within the first 24h of delivery. A low haemoglobin in the absence of symptoms was the most commonly documented reason for transfusion (43%). Most transfusions (76%) were requested by trainee doctors. Only 9% of patient notes documented that consent for transfusion had been sought and that potential risks were discussed with the patient. CONCLUSIONS: Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7 g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent.
BACKGROUND: Fears about safety and availability of blood in the United Kingdom have prompted efforts to encourage evidence-based blood transfusion in all areas of medicine, with increasing interest in the obstetric population. A retrospective one-year single-centre audit of obstetric red cell transfusions was conducted. METHODS: Study subjects were those given a red cell transfusion during their perinatal care between April 2006 and March 2007 inclusive. A pre-piloted data collection pro forma was used to collect information from maternity case notes on demographics, location of transfusion, ordering physician, reason for transfusion, counselling, consent, and related laboratory data. RESULTS: Two-hundred and two women were transfused during their perinatal care (30.8 per 1000 cases), 49% within the first 24h of delivery. A low haemoglobin in the absence of symptoms was the most commonly documented reason for transfusion (43%). Most transfusions (76%) were requested by trainee doctors. Only 9% of patient notes documented that consent for transfusion had been sought and that potential risks were discussed with the patient. CONCLUSIONS: Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7 g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent.