Butwick A J, Aleshi P, Fontaine M, Riley E T, Goodnough L T
Department of Anesthesiology (MC: 5640), 300 Pasteur Drive, Stanford University School ofMedicine, Stanford, California 94305, USA.
Int J Obstet Anesth. 2009 Oct;18(4):302-8. doi: 10.1016/j.ijoa.2009.02.005. Epub 2009 Jul 22.
The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center.
A retrospective, observational study was performed of obstetric in-patients who received red blood cell transfusion and/or blood products over a one-year period. Data abstracted included transfusion data, pre-transfusion hemoglobin (Hb) and lowest recorded (nadir) Hb, and maternal and neonatal outcomes.
During the study period, 74 patients received transfusion therapy (1.4%). Pre-transfusion and nadir Hb values were 7.6 g/dL and 7.0 g/dL respectively. Median [IQR] total red blood cells transfused were 2 units [2-3], with 41 (55%) patients receiving 1-2 units. Based on chart review, no specific indications for transfusion were identified in 25 patients (34%), and 13 patients (18%) had undetected postpartum anemia (Hb values <8.2 g/dL) at least 24h after delivery.
More formal assessment and documentation of the etiologic factors associated with transfusion management in pregnant patients is advised. In addition, the identification and management of undetected postpartum anemia is underappreciated.
医生通常凭经验决定使用红细胞输血和/或血液制品（新鲜冰冻血浆、血小板、冷沉淀）来处理产科出血或治疗产后贫血。我们进行了一项回顾性研究，以评估一家大型产科中心的孕妇和产后患者的输血结果。
对在一年期间接受红细胞输血和/或血液制品的产科住院患者进行了一项回顾性观察研究。提取的数据包括输血数据、输血前血红蛋白（Hb）和最低记录（最低点）Hb，以及母婴结局。
在研究期间，74例患者接受了输血治疗（1.4%）。输血前和最低点Hb值分别为7.6 g/dL和7.0 g/dL。输注红细胞的中位数[四分位间距]为2单位[2 - 3]，41例（55%）患者输注1 - 2单位。根据病历审查，25例患者（34%）未发现输血的具体指征，13例患者（18%）在分娩后至少24小时存在未被检测到的产后贫血（Hb值<8.2 g/dL）。
建议对与孕妇输血管理相关的病因因素进行更正式的评估和记录。此外，未被检测到的产后贫血的识别和管理未得到充分重视。
