ABSTRACT
BACKGROUND: Obstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high-income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion. STUDY DESIGN AND METHODS: A case-control study was conducted at four large South African hospitals. Transfused peripartum women (cases) and nontransfused controls were stratum matched 1:2 by hospital and delivery date. Data on obstetric, transfusion, and human immunodeficiency virus (HIV) history were abstracted from medical records. Blood was obtained for laboratory evaluation. We calculated unadjusted and adjusted odds ratios (ORs) for transfusion using logistic regression. RESULTS: A total of 1200 transfused cases and 2434 controls were evaluated. Antepartum hemorrhage (OR, 197.95; 95% confidence interval [CI], 104.27-375.78), hemorrhage with vaginal delivery (OR, 136.46; 95% CI, 75.87-245.18), prenatal anemia (OR, 22.76; 95% CI, 12.34-41.93 for prenatal hemoglobin level < 7 g/dL), and failed access to prenatal care (OR, 6.71; 95% CI, 4.32-10.42) were the major risk factors for transfusion. Platelet (PLT) count (ORs, 4.10, 2.66, and 1.77 for ≤50 × 109 , 51 × 109 -100 × 109 , and 101 × 109 -150 × 109 cells/L, respectively), HIV infection (OR, 1.29; 95% CI, 1.02-1.62), and admitting hospital (twofold variation) were also associated with transfusion. Mode of delivery, race, age category, gravidity, parity, gestational age, and birthweight were not independently associated with transfusion. CONCLUSION: Major risk factors of peripartum transfusion in South Africa, namely, prenatal anemia and access to prenatal care, may be amenable to intervention. HIV infection and moderately low PLT count are novel risk factors that merit further investigation.
Subject(s)
Blood Transfusion/statistics & numerical data , Postpartum Hemorrhage/therapy , Adolescent , Adult , Anemia/epidemiology , Birth Weight , Case-Control Studies , Cesarean Section , Female , Gestational Age , HIV Infections/epidemiology , Health Services Accessibility , Humans , Infant, Newborn , Odds Ratio , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Postpartum Hemorrhage/epidemiology , Pregnancy , Pregnancy Complications, Hematologic/epidemiology , Pregnancy Complications, Infectious/epidemiology , Prenatal Care , Risk Factors , South Africa/epidemiology , Young AdultABSTRACT
BACKGROUND: Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery. OBJECTIVE: To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG). METHODS: The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age, sex, clinical observations, indications for surgery, pre- and postoperative haemoglobin (Hb) values, comorbidities, length of hospital stay and transfusion history was recorded. RESULTS: The transfusion rate at HY (41.6%) was significantly higher than that at HG (10.0%). The mean postoperative Hb in the transfused patients at HG was 8.3 g/dL v. 9.1 g/dL at HY. Females had a significantly higher transfusion rate (33.0%) than males (15.0%) (p<0.05), and the mean age of transfused patients was significantly greater than that of untransfused patients (p<0.005). Although patients with comorbidities had a higher transfusion rate than those without, this did not reach statistical significance. Of 120 patients with complete data, 113 (94.2%) had a blood bank order, of which the vast majority, 102/113 (90.3%), were group-and-screen (G&S) requests; 29/113 (25.7%) were converted to a full crossmatch. CONCLUSIONS: Overall, the transfusion rate for both hospitals was 25.8%, which is well within published rates. A guideline Hb trigger of 8.0 g/dL is recommended as per published guidelines, with the caveat that the clinical judgement of the attending clinician whether a transfusion is indicated is paramount. Causes of preoperative anaemia should be investigated and treated. Routine cross-matching preoperatively is unnecessary, and a G&S order is sufficient.
ABSTRACT
Background. Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery.Objective. To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG).Methods. The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age; sex; clinical observations; indications for surgery; pre- and postoperative haemoglobin (Hb) values; comorbidities; length of hospital stay and transfusion history was recorded.Results. The transfusion rate at HY (41.6%) was significantly higher than that at HG (10.0%). The mean postoperative Hb in the transfused patients at HG was 8.3 g/dL v. 9.1 g/dL at HY. Females had a significantly higher transfusion rate (33.0%) than males (15.0%) (p0.05); and the mean age of transfused patients was significantly greater than that of untransfused patients (p0.005). Although patients with comorbidities had a higher transfusion rate than those without; this did not reach statistical significance. Of 120 patients with complete data; 113 (94.2%) had a blood bank order; of which the vast majority; 102/113 (90.3%); were group-and-screen (GetS) requests; 29/113 (25.7%) were converted to a full crossmatch.Conclusions. Overall; the transfusion rate for both hospitals was 25.8%; which is well within published rates. A guideline Hb trigger of 8.0 g/dL is recommended as per published guidelines; with the caveat that the clinical judgement of the attending clinician whether a transfusion is indicated is paramount. Causes of preoperative anaemia should be investigated and treated. Routine cross-matching preoperatively is unnecessary; and a GetS order is sufficient
