Postpartum Blood Transfusion in Stable Patients (325)

Objectives

To develop a policy of prescription of blood transfusion based on symptoms and signs rather than based on haemoglobin value. To minimize the number of units transfused without comprising the benefits of transfusion.

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Blood transfusion though life saving is not without hazards. The risk of complications (immunologic, non immunologic) increases with the volume of transfusion. It is important to avoid unnecessary exposure to allogenic blood products. Due to safety concerns, many recent studies on restrictive transfusion policy have been published and they have been shown to be effective.2,3,4 Moreover the number of red cell units ordered are not always utilised and can lead to significant wastage.1

Evaluation for transfusion in post natal ward

  • Haemodynamically stable
  • No evidence of ongoing haemorrhage, underlying medical disorder
  • Symptoms and signs of anaemia(palpitations, fatigue, fainting spells, shortness of breath, pale skin)
  • Haemoglobin value

Management

Haemoglobin
≥ 90g/l		Haemoglobin
70 - 89g/l		Haemoglobin
<70g/l
Iron therapyEvaluate signs & symptomsEvaluate signs & symptoms
Asymptomatic - alternative therapyDiscuss with senior
Symptomatic – prescribe single unitSymptomatic – transfuse as
indicated
Re evaluate after single transfusionSingle/multiple units
Still symptomatic – discuss with Senior
regarding further transfusion		Alternative therapy
  • Discuss the potential risks and benefits of blood transfusion with the patient and clearly document in the case notes.
  • Fully complete the Blood Component Prescription and Record of Transfusion form.
  • Alternative therapy – oral iron therapy, parenteral iron therapy
  • Seniors - Registrar, Consultant
  • Patient declining transfusion- Discuss with Seniors

Editorial Information

Last reviewed: 01/08/2022

Next review date: 31/08/2027

Author(s): Judith Roberts.

Version: 4

Approved By: Obstetrics Clinical Governance Group

Document Id: 325

References
  1. Retrospective study of postnatal ward blood transfusion in the Southern General hospital 2010
  2. Postpartum Blood Transfusion. Maternity Services Lothian guidelines, Departmental audit.
  3. Ma M, Eckert K, Ralley F, Chin- Yee I. A retrospective study evaluating single – unit red blood cell transfusions in reducing allogenic blood exposure. Transfuse Med 2005; 15(4): 307-312
  4. Naylor JM, Adie S, Fransen M, Dietsch S, Harris,I. Endorsing single – unit transfusion combined with a restrictive haemoglobin, transfusion threshold after knee arthroplasty. Qual Sa Health Care BmJ 2010; 239- 243
  5. UK Blood transfusion and Tissue transplantation guidelines