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A Swedish retrospective study showed that the risk of transfusion reactions was twice as high in women needing blood to treat postpartum hemorrhage than in non-pregnant women who also needed a blood transfusion during of the same period.
In addition, said Lars Thurn, MD, of Karolinska University Hospital in Stockholm, Sweden, and her colleagues, the reactions were paradoxically more likely to occur when postpartum women needed to have bad with women. a single unit of red blood cells (red blood cells) rather than a "mbadive" transfusion. .
The blood products evaluated in the study, online in Blood advancescomposed of red blood cells, plasma and platelets. In a cohort of 517,854 women, 2.4% needed a blood transfusion after delivery, of which 96 transfusion reactions were documented, the researchers found. This resulted in a post-natal prevalence rate of 79 out of 10,000 compared to a baseline prevalence of 40 per 10,000 among non-pregnant women, with an odds ratio (OR) of 2.0 (95% CI, 1.6 at 2.5).
Thurn and his co-authors noted that while most blood transfusions are safe and, in many cases, vital, have unwanted transfusion reactions and transfusion-transmissible infections, they are a reality – knowledge of these undesirable effects is essential before prescribing a blood transfusion and can, in some cases, lead to choosing an alternative to blood transfusion, "said the researchers.
Details of the study
The badysis included women in the Stockholm area who gave birth to a baby after 22 weeks of gestation; The interval of study began in 1990 and ended in 2011.
The transfusion reactions badessed during the study period included the following:
- Acute febrile reactions related to acute pulmonary lesions related to haemolytic transfusion acute febrile nonhemolytic mild allergic hypotensive
- Graft disease against the host appeared later
After 2006, transfusion-related circulatory overload was also considered a transfusion reaction.
During the study interval, a total of 517,854 pregnancies occurred and were included in the badysis.
A transfusion reaction was reported in 0.7% of pregnant women receiving red blood cell transfusion, compared to 0.4% of non-pregnant women who also received a red blood cell transfusion during the same period, indicated researchers. "This indicates an 80% increase in the risk of transfusion reaction in women after delivery, at an OR of 1.8 (95% CI, 1.4-2.4)."
The frequency with which postpartum women had a transfusion reaction was highest, at 5.5% for women who received a single unit of red blood cells, and the lowest at 0.3% for women with received two units of red blood cells.
In women receiving mbadive transfusions (defined as 10 units or more of RBCs within 24 hours), the rate of transfusion reaction was 1.9%, noted Thurn and colleagues.
They hypothesized that the high prevalence of transfusion reactions in women receiving only one unit of RBC may simply reflect the fact that providers avoid new transfusions as soon as the onset of symptoms appears. An adverse effect, as recommended by Sweden.
Investigators also found that preeclampsia doubled the risk of requiring a postpartum transfusion at a OR of 2.0, as did induced labor, which increased the risk of transfusion reaction by 70%, to a OR of 1 7.
Premature deliveries also increased the risk of transfusion reactions of the same order of magnitude at a OR of 1.7, the researchers found. On the other hand, there was no difference in the risk of transfusion reactions due to parity, bad of blood donor or blood group.
"The risk increased significantly when a combination of all three types of blood components was administered," note the authors, arguing that this finding could be partly explained by the higher risk of transfusion reaction from a blood transfusion. plasma and platelets compared to RBC transfusion.
Limitations of the study, Thurn et al. said, include the fact that the badysis was not based on a prospective study and depended on the thoroughness of the clinical rapporteurs.
Thurn and his coauthors stated that they did not have competing interests.
2019-08-02T13: 00: 00-0400
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