Blood transfusion needs among obstetric patients in a tertiary care hospital: a prospective observational study
Keywords:Blood transfusion, Component therapy, Transfusion reactions
Background: Pregnancy possess a special challenge as immune responses in pregnant and non-pregnant states are different. The objectives of this study were to analyze the various indications for blood and blood component transfusion in obstetric patients. To study the prevalence and indications for blood transfusion among obstetric patients. To evaluate the various risk factors among these women. To study the role of antenatal visits in patients requiring blood transfusion
Methods: A prospective observational study will be undertaken over a period of one year from July 2018 to June 2019 in Department of Obstetrics and Gynecology at SSIMS and RC, Davangere. This study was conducted on pregnant women and immediate postpartum patients (up to 7 days after delivery) admitted in Department of Obstetrics and Gynecology and requiring blood and blood component therapy. Statistical analysis will be performed using Chi square test and Student’s t test.
Results: During study period out of 5486 patients 543 patients required blood transfusion. The incidence of blood transfusion is 9.89%. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, incomplete abortion, complete abortion and hydatidiform mole. Anemia in pregnancy was the most common indication and was observed in 217 cases (39.96%) followed by postpartum hemorrhage, which was seen in 117 cases (21.54%). The incidence of transfusion reactions was 5.34% in our study.
Conclusions: A proper knowledge of blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. Regular Antenatal checkups should be given more importance in order to maximize the hemoglobin level at the time of delivery and to screen out the high-risk patients. Active management of the third stage of labor is required to minimize the blood loss. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion.
Schantz-Dunn J, Nour NM. The use of blood in obstetrics and gynecology in the developing World. Rev Obstet Gynecol. 2011;4(2):86-91.
Anjali K, Varsha K, Sulabha J, Anuja B, Bhavana K, Savita S. Blood transfusion in obstetrics and gynaecology: a retrospective analysis. Panacea J Med Sci. 2015;5(3):109-12.
McLintock C, James AH. Obstetric hemorrhage. J Thromb Haemost. 2011;9:1441-51.
Chhabra S, Namgyal A. Rationale use of blood and its components in obstetric-gynecological practice. J Mahatma Gandhi Inst Med Sci. 2014;19:93-9.
Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: a community-based study. J Family Med Prim Care. 2017;6(4):739-43.
The clinical use of blood. Blood transfusion safety. World health organization, Geneva 2002. Available at: http://www.who.int/bloodsafety/BTS_ ResolutionsAdopted.pdf.
Nigam A, Prakash A, Saxena P. Blood transfusion in obstetrics. Kathmandu Univ Med J. 2013;11(44):355-9.
Royal College of Obstetricians and Gynaecologists. Blood transfusion in obstetrics. Green-top Guideline No. 47. London (UK): Royal College of Obstetricians and Gynaecologists; 2007. Available at: https://www.rcog.org.uk/en/guidelines-research-services/ guidelines/gtg47/.
Chowdhury F, Akhter S, Islam A, Rayen J, Begum N, Begum F. Evaluation of blood transfusion practices in obstetrics and gynecology in a tertiary hospital in Bangladesh. J Bangladesh College Physicians Surgeons. 2016;34:9-14.
Chawla S, Bal MH, Vardhan BS, Jose CT, Sahoo I. Blood transfusion practices in obstetrics: our experience. J Obstet Gynaecol India. 2018;68(3):204-7.
Butwick AJ, Aleshi P, Fontaine M. Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric center. Int J Obst Anesth. 2009;18:302-8.
Bangal VB, Gavhane SP, Aher KH, Bhavsar DK, Verma PR, Gagare SD. Pattern of utilization of blood and blood components in obstetrics at tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2017;6(10):4671-6.
Patel VP, Patel RV, Shah PT, Patel CK. Study of role of blood transfusion in obstetric emergencies. Int J Reprod Contracept Obstet Gynaecol. 2014;3:1002-5.
Madhushree D, Metgud MC, Patil K. Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study. Indian J Health Sci Biomed Res. 2018;11(2):116.
British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the clinical use of red cell transfusions. Br J Haematol. 2001;113:24-31.
World Health Organization (WHO). Essential health technologies. Blood transfusion safety, 2011. Available at: http://www.who.int/ bloodsafety/en/Blood_Transfusion_Safety.pdf. Accessed on 14th June 2011.