Rush Margaret, Srinivas Sindhu K, Hamm Rebecca F
Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Am J Perinatol. 2024 May;41(7):831-833. doi: 10.1055/s-0043-1763503. Epub 2023 Feb 23.
We aimed to describe hemoglobin (Hb) change after transfusion in the nonacute postpartum anemic population in order to provide clinicians with appropriate expectations regarding Hb rise posttransfusion.
We performed a secondary analysis of a randomized controlled trial comparing initial transfusion with 1 unit of packed red blood cells (pRBCs) to 2 units pRBCs for postpartum women requiring nonacute transfusion ( = 66). Inclusion criteria were: age 18 years and older, Hb level either <7 g/dL or >7 g/dL with signs or symptoms of anemia, and > 6 hours postpartum without contraindication to transfusion. Hb assessment was performed 4 to 6 hours after initial transfusion. Hb change (ΔHb) was calculated as posttransfusion Hb minus randomization Hb. Our primary goal was to describe mean ΔHb per pRBC transfused at the 4- to 6-hour posttransfusion blood count. We also compared ΔHb per pRBC transfused by number of units transfused, body mass index (BMI), and symptoms (dizziness and/or fatigue) at time of posttransfusion assessment.
Participants were mean age 29, mean BMI of 27, and over 70% self-identified as black, 12% identified as white, and 9% as Asian race. Mean Hb prior to transfusion was 6.9 ± 0.6 g/dL. Mean ΔHb per pRBC transfused was 0.9 ± 0.4g/dL. There was no difference in ΔHb per pRBC by BMI category (normal weight < 25 kg/m: 1.1 ± 0.2 g/dL; overweight 25-29.9 kg/m: 0.9 ± 0.5 g/dL; obese ≥ 30 kg/m: 0.9 ± 0.5 g/dL; = 0.12). Finally, there was also no significant difference in ΔHb per pRBC by whether or not symptoms of anemia persisted after initial transfusion (1.0 ± 0.7 vs. 0.9 ± 0.4 g/dL, = 0.39).
Our data supports the classically accepted rise in Hb after pRBC of approximately 1 g/dL, regardless of BMI category or anemia symptomatology. The study population includes patients at highest risk of postpartum anemia. The results of our study provide important information for clinicians caring for postpartum patients with nonacute anemia.
· Postpartum anemia is a significant public health issue.. · Providers use hemoglobin change to assess response to blood transfusion.. · The established 1 g/dL change in Hb after transfusion is based on historic surgical populations.. · Our data suggests the 1 g/dL Hb change is applicable to postpartum patients..
我们旨在描述非急性产后贫血人群输血后血红蛋白（Hb）的变化，以便为临床医生提供关于输血后Hb升高的合理预期。
我们对一项随机对照试验进行了二次分析，该试验比较了对于需要非急性输血的产后女性（n = 66）输注1单位浓缩红细胞（pRBC）与2单位pRBC的效果。纳入标准为：年龄18岁及以上，Hb水平<7 g/dL或>7 g/dL且伴有贫血体征或症状，产后>6小时且无输血禁忌证。在首次输血后4至6小时进行Hb评估。Hb变化（ΔHb）计算为输血后Hb减去随机分组时的Hb。我们的主要目标是描述输血后4至6小时血常规检查时每输注1单位pRBC的平均ΔHb。我们还比较了按输注单位数、体重指数（BMI）和输血后评估时的症状（头晕和/或疲劳）划分的每输注1单位pRBC的ΔHb。
参与者的平均年龄为29岁，平均BMI为27，超过70%的人自我认定为黑人，12%为白人，9%为亚洲种族。输血前的平均Hb为6.9±0.6 g/dL。每输注1单位pRBC的平均ΔHb为0.9±0.4g/dL。按BMI类别划分，每输注1单位pRBC的ΔHb无差异（正常体重<25 kg/m²：1.1±0.2 g/dL；超重25 - 29.9 kg/m²：0.9±0.5 g/dL；肥胖≥30 kg/m²：0.9±0.5 g/dL；P = 0.12）。最后，按首次输血后贫血症状是否持续划分，每输注1单位pRBC的ΔHb也无显著差异（1.0±0.7 vs. 0.9±0.4 g/dL，P = 0.39）。
我们的数据支持经典的观点，即输注pRBC后Hb通常升高约1 g/dL，无论BMI类别或贫血症状如何。研究人群包括产后贫血风险最高的患者。我们的研究结果为照顾非急性贫血产后患者的临床医生提供了重要信息。
·产后贫血是一个重大的公共卫生问题。·医疗人员利用血红蛋白变化来评估输血反应。·既定的输血后Hb升高1 g/dL是基于既往手术人群。·我们的数据表明1 g/dL的Hb变化适用于产后患者。
