Background
The American Academy of Blood Banks recommends single-unit red cell transfusion protocols
across medicine to reduce transfusion complications and the use of a scarce resource.
There are minimal data regarding single-unit protocols in obstetrics.
Objective
We aimed to compare single-unit vs multiple-unit transfusion protocols for treatment
of hemodynamically stable postpartum anemia.
Study Design
We performed a randomized trial comparing initial transfusion with 1 unit of packed
red blood cells (single-unit protocol) to 2 units of packed red blood cells (multiple-unit
protocol) from March 2018 to July 2019. Women who required transfusion >6 hours postpartum
were approached for consent. Unstable vital signs, hemoglobin level <5 g/dL, hemoglobinopathy,
and cardiomyopathy were exclusion criteria for enrollment. Hemoglobin assessment and
standardized clinical evaluation were performed 4 to 6 hours posttransfusion; additional
packed red blood cells were given if indicated. The primary outcome was total units
transfused. Secondary outcomes included length of stay, endometritis, wound separation
or infection, venous thromboembolism, and intensive care unit admission within 30
days postpartum. Breastfeeding, depression, maternal attachment, and fatigue scores
were assessed at 4 to 9 weeks postpartum. A total of 66 women were required to detect
a 20% reduction in units transfused with a single-unit protocol (power=80%; α=0.05).
Results
A total of 66 women were randomized (33 per arm). There were no differences between
groups in demographic or clinical characteristics, including delivery mode, blood
loss, and randomization hemoglobin levels. The mean number of units transfused was
lower in the single-unit protocol than in the multiple-unit protocol (1.2 U vs 2.1
U; P<.001). Only 18.2% of women in the single-unit arm required additional packed red
blood cells. At posttransfusion assessment, women in the single-unit arm had lower
hemoglobin levels (7.8 g/dL vs 8.7 g/dL; P<.001), but there were no differences in vital signs or symptoms between groups. There
were also no differences in length of stay, 30-day complications, or 4 to 9 week postpartum
outcomes.
Conclusion
In women with hemodynamically stable postpartum anemia, a single-unit protocol avoided
a second unit of packed red blood cells in >80% of women without significant impact
on morbidity. Our work supports the use of single-unit initial transfusion in this
population.
Key words
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Article info
Publication history
Published online: July 08, 2020
Accepted:
July 7,
2020
Received in revised form:
June 7,
2020
Received:
April 8,
2020
Footnotes
The authors report no conflicts of interest.
This research was funded by the National Improvement Challenge for Obstetric Hemorrhage through the Council for Patient Safety in Women's Health and a T32 Training Grant to the University of Pennsylvania by the National Institutes of Health (T32HD007440).
None of the funders had any role in the study design, data collection, data analysis, interpretation of data, the writing of the report or the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
This study was registered on ClinicalTrials.gov (clinical trial number NCT03419780).
Cite this article as: Hamm RF, Perelman S, Wang EY, et al. Single-unit vs multiple-unit transfusion in hemodynamically stable postpartum anemia: a pragmatic randomized controlled trial. Am J Obstet Gynecol 2021;224:84.e1-7.
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