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An Impact Study of Cell Salvage Blood Transfusion Practice in a Community Maternal Hospital in China
Abstract Number: S-53
Abstract Type: Original Research
Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal death in China and the world. Allogeneic blood transfusion (RBCT) is an important component of the treatment of PPH. The use of autologous blood obtained via cell salvage blood transfusion (CSBT) has been controversial in obstetric practice because of limited safety data. The current study is designed to investigate the impact of CSBT on safety and blood transfusion (BT) practice in cesarean delivery (CD) parturients (Pts) at high risk for PPH.
Methods: The data was obtained from the database of the blood bank, the billing case log of CSBT， and the electronic medical records in all the Pts who underwent CD and BT in Ningbo Women and Children's Hospital in China during a 48–month period (10/01/2010 – 09/30/2014). There were three phases in the study, baseline (10/01/2010-05/31/2011), implementing (06/01/2011-07/31/2012), and practice (08/01/2012 – 09/30/2014) based on CSBT usage (0.01%, < 45%, >45%, respectively). Transfusion triggers were 8 g/dL and 10 g/dL, for RBCT and CSBT, respectively. The primary outcomes were saved RBCT units/CD, adverse reactions to BT, and hospital discharge Hgb levels in transfused Pts. The secondary outcomes were parameters related to transfusion rates of other blood products, postpartum coagulation profiles, infection issues, ICU stay, and hospitalizations. All rates related to transfusion of CSBT were adjusted by RBCT rate in the baseline phase. All ordinal and continuous data are assessed with Kolmogorov-Smirnov test for normality, and analyzed with χ2, Student t-Test, or Mann-Whitney U test. P < 0.01 was considered significant.
Results: A total of 794 Pts out of 23,462 CD receiving either RBCT (346) or CSBT (448) were included in the study. The proportion of RBCT and CSBT during the study period is illustrated on Fig 1a. Basic characteristics among Pts were comparable in the three phases. On Fig 1b, three units (medium) of allogeneic RBC/CD were saved and the rate of adverse reactions was lower (RR 0.16, 95%CI: 0.07-0.34) with 0% in all CSBT Pts, and lower postoperative BT rate (RR 0.63, 95%CI: 0.44-0.90) . Other outcomes appear on Table 1. Wasted cell salvage collection rates, however, were 25% in Implementing Phase and 50% in Practice Phase.
Conclusions: CSBT saved allogeneic RBCT with a lower transfusion-related adverse reaction rates and higher individual postoperative Hgb level without compromising outcomes but 50% risk of financial costs