Evaluating Blood Transfusion Management in Obstetrics & Maternity

This report provides an analysis of blood transfusion management in obstetrics and maternity, focusing on the guidelines outlined in Module 5. It discusses the common practice of blood transfusion in obstetrics due to acute blood loss from conditions like placenta praevia and postpartum complications, while also acknowledging the associated risks, such as transfusion reactions. The report analyzes the strengths and weaknesses of Patient Blood Management Guidelines, specifically concerning blood group screening, blood transfusion during anaemia, situations where transfusion is not an option, and Cytomegalovirus (CMV) seronegative transfusion. It emphasizes the importance of routine antibody and blood group testing during pregnancy, screening for anaemia risk factors, optimizing haemoglobin during the antenatal period, and offering CMV-safe blood products to pregnant women. The report concludes that proper precautions, blood screening, and patient education are crucial in reducing adverse transfusion reactions, advocating for early involvement of consultant obstetricians, haematologists, anaesthetists, and blood bank professionals.

Blood transfusion in obstetric
Blood transfusion in obstetric is a common practise. Acute blood loss in
obstetrics mainly occurs due to placenta praevia, post partum conditions
and other surgery related complications during caesarean (Patterson et
al. 2014). However, the process of blood transfusion in obstetric or
maternity is not devoid of risk. The occurrence of blood transfusion
reactions differs from 4 among 100 transfusion cases for non-haemolytic
reactions. Among haemolytic transfusion, the ratio is 1 out of every
40,000 cases (Nigam, Prakash & Saxena 2013).
Blood Transfusion Reaction: Evidences
According to the Australian Red Cross Blood Service (2017), obstetric
haemorrhage might occur either before or after the delivery
however, at least 80% of cases are postpartum. Throughout the
world, huge obstetric haemorrhage mainly results from the failure of
the standard obstetrical and systemic haemostasis and accounts for
about 358,000 of maternal death annually. The statistics highlighted
by the Australian Red Cross Blood Service (2017) showed that
transfusion reaction complicates more than 10% of cases in Australia
with obstetric haemorrhage amounting to about 3 to 6%.
Evaluation of transfusion process guidelines
According to Nigam, Prakash and Saxena (2013), there are no
established parameters for starting the red blood cell transfusion
and the decision of transfusion is entirely based on the
haematological and clinical physiological parameters. However,
National Blood Authority (NBA) of Australia has proposed Patient
Blood Management Guidelines in Obstetrics and Maternity.
Analysis of strength and weakness of Patient Blood Management Guidelines: Obstetrics and Maternity
Guidelines: Blood Group Screening
According to NBA (2017), all women should be offered routine antibody and blood group testing during pregnancy and this will
progressed further via screening from the Rh D negative antibodies among the women with or without alloantibodies. This
screening must also be done at the time of admission or during labour or before caesarean or vaginal birth in order to avoid any
potential delay in the process of blood transfusion. Moreover, the decision in the domain of antibody screening during vaginal or
caesarean birth must include risk assessment in the domain of peripartum haemorrhage.
Guidelines: Blood transfusion during anaemia
According to NBA (2017) women with high risk of anaemia must be tested for ferritin during pregnancy in order to assess iron
stores and other risk factors for anaemia. Other factors which contributes different types of anaemia like vitamin B12 should also
be screened. Moreover, women must be educated with the information in relation to minimising anaemia in order to avoid blood
transfusion during pregnancy. The education must come in the domain of healthy diet, optimal management of medical
comorbidities and spacing of pregnancies. According to Jadon and Bagai (2014), this education helps in early correction of anaemia
and thereby avoiding the chances for the requirement for blood transfusion. In the domain of ferreting, Khambalia et al (2016) is
of the opinion that detection of iron deficiency during pregnancy via screening serum ferritin helps to reduce birth related
complications. Amiri et al. (2013) further opined that this process is helpful for treating patients with or without gastrointestinal
diabetes.
Guidelines: When transfusion is not an option
NBA (2017) must optimise haemoglobin during antenatal period in order to reduce the blood loss during child birth. NBA has also
proposed in favour of hysterectomy in favour of blood loss. However, Clarke-Pearson and Geller (2013) have opined that
hysterectomy is associated with numerous complications. Hodges, Davis and Swaim (2014) stated the complications which include
like venous thromboembolism, gastrointestinal tract and genitourinary tract injection and nerve injury.
Guidelines for Cytomegalovirus (CMV) seronegative transfusion
NBA (2017) is of the opinion that CMV safe blood products should be offered to all pregnant women irrespective of their CMV
status. However, Ziemann et al. (2013) is of the opinion that CMV is also detected in the plasma of the seropositive donors. Proper
selection of the leukoreduced blood products from donors with remote CMV infection will help to avoid transfusion-transmitted
CMV infections arising out of primarily infected donors. Josephson et al. (2014) stated that CMV blood transfusion is crucial
because postnatal CMV can lead to serious mortality and morbidity among the very low birth weight infants.
Conclusion
Thus from the above discussion it can be concluded that proper
precaution, blood screening along with patient education helps to
reduce the adverse transfusion reaction among the obstetrics
patients of the maternity ward. Apart from abiding by the guidelines
as proposed by the Patient Blood Management Guidelines: Obstetrics
and Maternity as proposed by the National Blood Authority of
Australia,, an early involvement of the consultant obstetrician,
haematologist, anaesthetist and other blood bank professionals is
essential in order to detect the chances of blood transfusion
reactions and thereby shielding it accordingly.
Analysis of the blood transfusions management in
Obstetrics and Maternity
Presented by:
(Image Source: Klein
& Anstee 2014)
(Image Source: Klein
& Anstee 2014)
(Image Source: Klein
& Anstee 2014)
(Image Source: Klein
& Anstee 2014)

References
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doi: 10.4103/0976-9668.116977
• Australian Red Cross Blood Service 2017. Obstetric haemorrhage. Access date: 12th April. Retrieved from:
https://transfusion.com.au/transfusion_practice/obstetric_transfusion
• Clarke-Pearson, D.L. & Geller, E.J., 2013. Complications of hysterectomy. Obstetrics & Gynecology, 121(3), pp.654-673.
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pp.43-57. Retrieved from: https://repositorio-aberto.up.pt/bitstream/10216/83719/2/131321.pdf
• Jadon, A. and Bagai, R., 2014. Blood transfusion practices in obstetric anaesthesia. Indian journal of anaesthesia, 58(5), p.629.
• Josephson, C.D., Caliendo, A.M., Easley, K.A., Knezevic, A., Shenvi, N., Hinkes, M.T., Patel, R.M., Hillyer, C.D. & Roback, J.D., 2014. Blood transfusion and
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http://www.kumj.com.np/issue/44/355-359.pdf
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https://www.blood.gov.au/system/files/documents/pbm-mod-5_0.pdf
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