Single vs. Two-Unit Transfusion for Hemodynamically Stable Postpartum Anemia: Less is More

Objective: Postpartum anemia (PPA) occasionally may necessitate transfusion of packed red blood cells (pRBCs). There has been debate among obstetricians regarding administering a single unit as opposed to two-unit protocol. A recent trial showed that using the single unit protocol avoided transfusion of the second unit in 80% of patients. However, risk factors for identifying patients who would benefit from two units of pRBCs had not been evaluated.

Methods: Retrospective cohort study during 2010–2020. The study group included women with PPA who received transfusion of pRBCs. The groups were divided into patients who received single versus two units of pRBCs. The primary outcome was to identify risk factors that demand a two-unit protocol.

Results: The final analysis included 368 women who received single unit compared with 317 women receiving two units pRBCs. In univariate analysis, the duration of cesarean delivery (56.6 ± 35.8 vs. 45.5 ± 18.5 min, p=0.0063), episiotomy during vaginal delivery, lowest postpartum mean Hb levels (6.6 ± 0.6 g/dl vs. 6.9 ± 0.5 g/dl, p=0.0001) and mean delta of Hb levels (4.3 ± 1.5 g/dl vs. 3.9± 1.5 g/dl, p=0.002) were significant risk factors for requiring two pRBCs compared to a single unit. Despite our findings, in a multivariate analysis, none of the risk factors was significantly associated with the two-pRBCs protocol.

Conclusions: Our study supports the practice of single unit protocol in patients with PPA regardless of the risk factors present. Following these guidelines will help obstetricians reduce costs and morbidity associated with pRBCs transfusion.

Note:

Funding Information: The authors did not receive any funding for this study.

Declaration of Interests: The authors report there are no competing interests to declare.

Ethics Approval Statement: As required by Israeli law and regulations, the study was approved by the Rambam Health Care Campus Research Ethics Board (RMB 0455-20), waiving written informed consent for de-identified patient data. Approval granted 1 June 2020.

Keywords: Postpartum, anemia, transfusion, pregnancy

Suggested Citation: Suggested Citation

Ben David, Chen and Inbal, Or and Iluz, Roee and Weissman, Amir and Khatib, Nizar and Ginsberg, Yuval and Beloosesky, Ron and Weiner, Zeev and Solt, Ido and Vitner, Dana and Bonstein, Lilach and Zipori, Yaniv, Single vs. Two-Unit Transfusion for Hemodynamically Stable Postpartum Anemia: Less is More. Available at SSRN: https://ssrn.com/abstract=4282787 or http://dx.doi.org/10.2139/ssrn.4282787