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Clinical Predictors of Cell Salvage Blood Collection Transfusions
Abstract Number: S-23
Abstract Type: Original Research
Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal death in China and the world. Cell salvage blood transfusion in obstetrics has been used as a means of reducing allogeneic transfusions. However, cell salvage is not indicated for all procedures, as most patients do not have PPH or require allogeneic transfusions. The current study was designed to investigate predictors of cell salvage blood collection (CSBC) transfusion in cesarean delivery parturients at high risk for PPH.
Methods: The data were collected retrospectively from electronic medical records at the Ningbo Women and Children’s Hospital, Zhejiang, China. Patients who underwent cesarean delivery and had CSBC only or CSBC transfusion (identified from the billing case log in the Department of Anesthesiology) during the 26-month study period (August 2012 – September 2014, CSBC transfusions use accounted > 45% of all blood transfusions) were included in the study. The clinical practice was to transfuse CSBC when the Hgb < 10.0 g/dL. The primary outcome was CSBC transfusion. Patient and laboratory variables were compared between subjects with and without CSBC transfusion using χ2, Student t-Test, or Mann-Whitney U test. Variables with P<0.10 were entered into a stepwise logistic regression analysis model. Model validation was performed by bootstrapping and performance was evaluated using the c-statistic. Sensitivity, specificity, positive and negative predictive value of the model for predicting CSBC transfusion were calculated. P<0.05 was required to reject the null hypothesis.
Results: A total of 873 cesarean delivery parturients with high risk of PPH were selected for cell salvage; the CSBC units were transfused in 435 cases and wasted in 438 cases. Clinical characteristic of the groups are shown in the Table 1, along with possible predictors of CSBC transfusion. The positive predictors included neonatal weight, placenta increta/percreta, complete placenta previa, placenta previa with previous uterine surgery; negative predictors were placental abruption and preoperative lab studies (Hgb, platelet count, and fibrinogen). The model predicted 77% of CSBC transfusion improved by 27% from the current 50% of wasted CSBC. The sensitivity and the specificity were 65% and 74%, respectively.
Conclusions: The model developed in study, if validated, may help decrease CSCB wasting and improve cost effectiveness of the transfusion practice.