Department of Research and Development, Sanquin Bloodbank South West Region, Leiden, The Netherlands.
Vox Sang. 2010 Jan;98(1):65-9. doi: 10.1111/j.1423-0410.2009.01231.x. Epub 2009 Aug 17.
Despite published guidelines, a proportion of red blood cell (RBC) transfusions seem unnecessary. To evaluate the indications for and the appropriateness of RBC transfusions in the postpartum patient, we performed a retrospective audit over a 1-year period in two Dutch hospitals.
Observational study of transfused obstetric patients, admitted in 2006 to the Departments of Obstetrics of a university and a general hospital, was carried out. Relevant clinical and laboratory data were recorded. The appropriateness of RBC transfusions was assessed using the national and age-based transfusion guidelines for the general population; for the studied group the transfusion threshold haemoglobin (Hb) value was 6.4 g/dl for non-massive and 8.1 g/dl for massive blood loss. From these we derived target Hb levels.
Ninety patients received one or more RBC units within 48 h of delivery. Mean pretransfusion Hb level was 6.9 [SD 1.2] g/dl. Median number of transfusions was 2. Mean Hb level at discharge was 9.7 [SD 1.1] g/dl. Taking threshold Hb and the derived target Hb level into account, 68% (n = 61) of the patients may have received one or more RBC units inappropriately. Of 311 RBC units transfused, 143 units (46%) were possibly inappropriate, partly due to over-transfusion.
A significant proportion of postpartum RBC transfusions are possibly inappropriate, partly due to over-transfusion. If current guidelines would be more specific, in particular, with respect to the target Hb levels, the total amount of RBC transfusions may be considerably decreased.
尽管有相关指南，但仍有部分红细胞（RBC）输注似乎并无必要。为了评估产后患者 RBC 输注的适应证和合理性，我们在荷兰的两所医院进行了为期 1 年的回顾性审计。
对 2006 年入住大学和综合医院妇产科的接受输血的产科患者进行观察性研究，记录相关临床和实验室数据。使用国家和基于年龄的一般人群输血指南评估 RBC 输注的合理性；对于研究组，非大量失血的输血阈值血红蛋白（Hb）值为 6.4 g/dl，大量失血的输血阈值 Hb 值为 8.1 g/dl。由此我们得出目标 Hb 值。
90 例患者在分娩后 48 小时内输注了 1 个或多个 RBC 单位。输血前平均 Hb 水平为 6.9[1.2]g/dl。中位数输注次数为 2 次。出院时的平均 Hb 水平为 9.7[1.1]g/dl。考虑到阈值 Hb 和得出的目标 Hb 水平，68%（n=61）的患者可能接受了 1 个或多个不必要的 RBC 单位输注。在输注的 311 个 RBC 单位中，143 个（46%）可能不合适，部分原因是过度输血。
产后 RBC 输注的很大一部分可能不合适，部分原因是过度输血。如果当前的指南更具体，特别是关于目标 Hb 水平，那么 RBC 输注的总量可能会大大减少。
