Parker J, Thompson J, Stanworth S
Department of Obstetric Anaesthesia, Women's Centre, John Radcliffe Hospital, Oxford, UK.
Int J Obstet Anesth. 2009 Oct;18(4):309-13. doi: 10.1016/j.ijoa.2009.05.008. Epub 2009 Sep 2.
Fears about safety and availability of blood in the United Kingdom have prompted efforts to encourage evidence-based blood transfusion in all areas of medicine, with increasing interest in the obstetric population. A retrospective one-year single-centre audit of obstetric red cell transfusions was conducted.
Study subjects were those given a red cell transfusion during their perinatal care between April 2006 and March 2007 inclusive. A pre-piloted data collection pro forma was used to collect information from maternity case notes on demographics, location of transfusion, ordering physician, reason for transfusion, counselling, consent, and related laboratory data.
Two-hundred and two women were transfused during their perinatal care (30.8 per 1000 cases), 49% within the first 24h of delivery. A low haemoglobin in the absence of symptoms was the most commonly documented reason for transfusion (43%). Most transfusions (76%) were requested by trainee doctors. Only 9% of patient notes documented that consent for transfusion had been sought and that potential risks were discussed with the patient.
Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7 g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent.
对英国血液安全性和可获得性的担忧促使人们努力在医学各领域鼓励基于证据的输血，产科人群对此的关注度也日益增加。我们对产科红细胞输血进行了一项为期一年的单中心回顾性审计。
研究对象为在2006年4月至2007年3月（含）围产期护理期间接受红细胞输血的患者。使用预先试点的数据收集表格从产妇病历中收集有关人口统计学、输血地点、开单医生、输血原因、咨询、同意情况及相关实验室数据的信息。
202名女性在围产期护理期间接受了输血（每1000例中有30.8例），49%在分娩后的头24小时内。在无症状情况下血红蛋白水平低是最常记录的输血原因（43%）。大多数输血（76%）由实习医生申请。只有9%的患者病历记录了已寻求输血同意并与患者讨论了潜在风险。
总体而言，红细胞输血的阈值似乎较低，31%的输血发生在血红蛋白>7 g/dL且无持续出血或贫血症状的情况下。根据皇家妇产科学院的指南，此类输血被认为是不适当的。主要建议是在所有产科单位实施教育计划和指南，减少血液使用并鼓励记录适当的同意情况。
