Triggers and appropriateness of red blood cell transfusions in the postpartum patient–a retrospective audit

Background and Objective  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.
Study Design and Methods  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.
Results  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.
Conclusion  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.