Blood Transfusion Practice in Obstetric and Gynecology: Impact of Educational Programs to Create Awareness for Judicious Use of Blood Components

Abstract

The study presents the data analysis (1) To find out the trend of blood component use during the period 2003-2010 and to determine impact of component awareness programs on reduction in whole blood (WB) and single unit transfusions. (2) To determine Hb trigger. The details about blood units issued were entered in the integrated blood bank management software as well as in Microsoft Excel. The data of 4,838 cases of pregnancy anemia; 2,244 receiving blood for obstetric (Ob) hemorrhage including 270 cases of disseminated intravascular coagulation; 1,413 women having Gynecological (Gy) bleeding; 911 Ob, 2,032 Gy and 740 surgeries for Gy malignancy were analyzed. During the years 2003-2010 there was gradual increase in component utilization for pregnancy anemia, Ob/Gy surgeries and Ob/Gy bleeding and significant reduction in WB transfusions due to component awareness programs. But single unit transfusions showed comparatively lower trend of reduction. The mean Hb was 6.4 g/dL for pregnancy anemia, 8.1 g/dL for surgeries and 7.3 g/dL for Ob/Gy bleeding.

Outcome of audit and education on blood transfusion practice in obstetrics setting

“…The overall blood transfusion rate in this study accounts for 7.8%, which correlates with other similar studies conducted in India. 5 Although the goal of modern transfusion practice is to provide appropriate replacement therapy with required components, 10 34.6% of whole blood transfusion was observed in Phase 1, of which 43.2% is accounted for in the management of chronic anemia ( Table 3 ). It is important to be aware that whole blood transfusion carries the risk of volume overload in chronic anemia patients and is indicated only in the management of acute blood loss, if components are unavailable.…”

“…In a study by Parker et al, a low hemoglobin level, in the absence of symptoms, was reported as the most common reason for red cell transfusion, while other studies in the literature have documented different reasons for the inappropriate use of packed red blood cells. 5 , 11 , 12 …”

“…However, concerns about safety, cost, availability of blood components and associated risks and complications, such as transfusion reactions, transmission of infections and alloimmunization, have promoted the need for greater scrutiny of blood transfusion practice. 5 Furthermore, a prompt decision in patient blood management, such as the selection of appropriate blood components or adoption of conservative strategies based on clinical and laboratory evaluation, including point-of-care coagulation tests, such as thromboelastography (TEG), and the continuous monitoring of transfusion activity through effective communication with the transfusion team, may help to improve transfusion practice. Therefore, we planned to evaluate the appropriateness and rational use of blood components in the obstetrics setting at our center and, in the light of the results, to identify key areas which require educational intervention to improve blood transfusion practices, based on the clinical evidence obtained at our hospital.…”

Study of blood component therapy in obstetrics

“…9 Therefore clinicians must prevent single unit transfusion in adult patients which can raise Hb only by 1-1.5g/dL. 10 WHO strongly discourages single unit transfusion. 11 The practice of single unit transfusion is largely avoidable.…”

Dr. Bhatia′s legacy in the development of immunohematology research in the country

“…Life of Dr. H. M. Bhatia (1928–1988) has been briefly recorded in his obituary,[ 1 ] and recently in a biographical sketch. [ 2 ]…”