Blood Transfusions in Obstetrics: Past, Present and Future

The history of transfusion medicine took a turn after the discovery of blood types and blood storage possibilities at the beginning of the 20th century. Although complications as a result of blood product transfusions have since dramatically decreased, minor to fatal complications still exist and give reason to limit administration in situations where possible risks outweigh the benefits. New guidelines have been published in order to reduce the number of unnecessary blood product transfusions. Unfortunately past papers show that the new guidelines are not yet fully implemented. In Switzerland no recent study has been published in regards to the administration of blood products. Therefore the goal of our retrospective study is to calculate the trend and evaluate the practice of transfusion medicine at the University Hospital of Zurich in the department of Obstetrics. Women who gave birth and received at least one red blood cell, platelet or fresh frozen plasma (FFP) transfusion where selected from the department’s database. Complete information was found for 241 cases from January 1996 to February 2007. Information was collected from the department’s computer programs, completed and compared with archive data. Data was collected in regards to: demographics, type of delivery, blood loss, number and type of transfusions received, hematological lab values, patient complications, complications during and after labor, and type of anemia treatment. Although we expected to see a decreasing trend in red blood cell transfusions, our results show an increasing percentage of patients receiving blood transfusions after the year 2004. Furthermore, our data shows a number of FFP, platelet and red blood cell (RBC) transfusions being administered inappropriately with discrepancies in data administration. Educational outreach and quality assurance checks are options, which could help improve the acknowledgment, understanding and administration of the practice of blood product transfusion in our clinic.