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Blood transfusion in childbirth: Does it matter if you're preeclamptic?
Abstract Number: F-15
Abstract Type: Original Research
Although hemorrhage remains one of the most important causes of maternal peripartum mortality, few studies have attempted to identify risk factors for peripartum hemorrhage (1,2,3). One potential risk factor might be preeclampsia. Preeclampsia can result in intravascular volume depletion, poor organ perfusion, and thrombocytopenia as part of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Preeclamptic patients could be at higher risk for red blood cell transfusion because of magnesium sulfate-induced uterine relaxation, prolonged induction of labor, impaired platelet function from aspirin ordered by obstetricians, or from thrombocytopenia. We hypothesized that preeclampsia is associated with an increased risk of transfusion during vaginal delivery or cesarean section, when compared to patients without preeclampsia.
We used an IRB-approved transfusion database described previously (3). Data collected from 2009 to 2015 were analyzed retrospectively, which included patient characteristics and diagnoses, mode of delivery, and administration of blood products. We identified a subset of patients with preeclampsia as diagnosed by the obstetrician. No patients were excluded. Numbers of patients who underwent red blood cell transfusion were compared in the two groups by t-test and one way analysis of variance.
RESULTS: A total of 4447 and 917 patients without and with preeclampsia, respectively, underwent either vaginal delivery or cesarean section. Mean admission hemoglobin was lower for preeclamptics mean 11.2 (std dev 1.49) than those for nonpreeclamptics 11.4 (std dev 1.41, P<0.0076). The lowest hemoglobin revealed a similar trend: preeclamptics 9.73 (std dev 1.76) and nonpreeclamptic 10.4 (std dev 1.76, P<0.001). Preeclamptics received more red blood cell transfusion during their total hospital stay with mean 0.27 (std dev 1.29) compared to nonpreeclamptics 0.13 (std dev 0.85, P<0.007). Interestingly, preeclamptics had lower last hemoglobin prior to discharge at mean 10.2 (std dev 1.63) compared to nonpreeclamptics at mean 10.6 (std dev 1.65, P<0.0002).
CONCLUSIONS: We observed that preeclamptic patients received significantly more blood transfusions than nonpreeclamptic parturients during their hospital stay. Interestingly, they were also more anemic on admission and prior to discharge, despite the increased blood transfusion. Despite the less pronounced dilutional anemia due to intravascular depletion, and despite the uncommon incidence of HELLP syndrome, preeclamptics may still receive more red blood cell transfusion due to thrombocytopathia or inefficient uterine tone post delivery, for example. Knowledge of the increased risk of transfusion may lead to earlier recognition and improved care.
1. Am J Obsetet Gynecol 2016 214:1SUPPL.1(S132-S133).
2. Vox Sanguinis 2010 99SUPPL.1(427)
3. Am J Obsetet Gynecol. 2013 Nov;209(5)499.e1-7.
4. Transfusion 2013;53:3052-3059