Blood transfusion during pregnancy safe

Blood Transfusions During Pregnancy

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A blood transfusion is a frequently performed procedure where you receive blood through an intravenous (IV) line into one of your blood vessels. Receiving a blood transfusion while pregnant is not something most women want to think about. However, there are two conditions that may warrant a blood transfusion during pregnancy.

What are the Reasons to Have a Blood Transfusion During Pregnancy?

There are two primary reasons you may need a blood transfusion while pregnant. These include the development of severe anemia close to your due date, or hemorrhaging at some point during your pregnancy.

You can find more information on both below:

Iron-Deficient Anemia

Once a hemoglobin estimate has been performed, a medical professional can diagnose the extent of your anemia. For patients diagnosed with severe anemia, it is important to determine the causes and best course of treatment.

While it may be difficult to pinpoint exact causes of anemia, particularly if a combination of factors has resulted in anemia, sometimes the frequency of anemia in a given region may give a clue as to its cause. For instance, in areas where malaria is common, the course of treatment will be tailored to take into account the possibility of malaria. Your doctor will prescribe antimalarials possibly in combination with another treatment.

If you have a hemoglobin count lower than 7 g/dl and are 34 weeks along in your pregnancy or more, the possibility of transfusion will be discussed. A hemoglobin measure lower than 5 g/dl greatly increases your risk of mortality. It is crucial you receive a transfusion before very severe anemia develops. In addition, it is imperative that severe anemia is effectively treated before labor. Often, relatives who are willing to donate blood are asked to provide the transfusion.

Hemorrhage

Hemorrhaging is bleeding excessively in an urgent situation. This bleeding can lead to severe anemia. A transfusion is often required in order to counteract excessive blood loss. Hemorrhaging can occur at any time during pregnancy. If you experience a miscarriage or ectopic pregnancy, it can lead to hemorrhaging early in your pregnancy.

It is also possible to experience hemorrhaging after your 24th week of pregnancy. You are probably more familiar with the possibility of hemorrhaging during delivery and immediately following delivery, known as intrapartum hemorrhaging and postpartum hemorrhaging respectively. While doctors will try to prevent the need for a blood transfusion, under some conditions it is absolutely necessary to save you and your baby’s life.

Having a Blood Transfusion During Pregnancy

Most often, the transfusion required for pregnant and recently pregnant women only involves red blood cells. It is less likely platelets and plasma will be needed. In order to receive the transfusion, a small tube will be inserted into a vein in your hand or arm.

The transfusing blood will move through a drip into your body. Each bag contains approximately 1/3 of a liter of blood and takes an estimated 3 hours to fully transfuse. In some cases, this rate of transfusion can be expedited.

What are the Side Effects of a Blood Transfusion While Pregnant

You will be closely monitored during any blood transfusion while pregnant by a health care professional.

Minor side effects include:

These side effects can be alleviated by medication and typically get better in one day.

More serious complications include the following:

  • Difficulty breathing
  • Severe headache
  • Abrupt drop in blood pressure that may be characterized as life-threatening

Once you experience side effects, the transfusion will be halted, and your current situation will be assessed before proceeding. Under conditions of massive transfusion or multiple transfusions, more severe pregnancy complications may arise.

These complications include:

  • Hypothermia
  • Hyperkalemia – electrolyte imbalance involving low potassium levels
  • Hypocalcemia – low calcium levels
  • Coagulopathy – clotting factors are diluted leading to weakened or impaired coagulation
  • 2, 3-DPG depletion – depletion of a blood component that regulates how easily oxygen is moved from hemoglobin into tissue
  • Jaundice
  • Infection
  • Alloimmunization
  • Transfusion Reactions

When these severe side effects are experienced, a medical team will intervene.

Blood Transfusions During Pregnancy: Final Notes

If you’re asked to undergo a blood transfusion, make sure to get a full understanding of all of the options available to you. If it is an emergency situation, a doctor will likely make an educated decision for you. You can decline a blood transfusion or change your mind about receiving one at any time, but be aware that under some circumstances a blood transfusion may be the only way to keep you alive. If you have any questions about your options or concerns about the safety of blood transfusions, you can ask your doctor or midwife.

Compiled from the following sources:

Cohen, Wayne R. (2000). Postpartum Hemorrhage and Hemorrhagic Shock in Cohen, Wayne R. (Ed.), Complications of Pregnancy, 5 th edition (812-3). Philadelphia, PA: Lippincott Williams & Wilkins.

MacDonald, R. (1977). Red cell 2,3-diphosphoglycerate and oxygen affinity. Anaesthesia, 32(6). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/327846

Royal College of Obstetricians and Gynaecologists. (2009, Feb. 20). Blood transfusion, pregnancy and birth – information for you.

Royal College of Obstetricians and Gynaecologists. (2009, Feb.). Blood transfusion, pregnancy and birth – information for you.

Walraven G. Treatments for iron-deficiency anaemia in pregnancy: RHL practical aspects (last revised: 20 June 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.

Blood transfusion during pregnancy safe

No. The carriers or sickle cell trait individuals usually have normal pregnancies and the risks of pregnancy complications mentioned above are comparable to those of the average population.

Are there special precautions required by a sickle cell disease sufferer before she conceives?

What special measures do these women require during pregnancy?

Why is blood transfusion likely to be necessary for SCD sufferers?

These women are chronically anaemic and pregnancy will inevitably worsen this. Anaemia puts a strain on vital organs, including the heart, and weakens the individual. This has to be prevented as much as possible.

If blood transfusion is that beneficial, why is it not given as a matter of course to every pregnant SCD sufferer?

One wishes solutions were that simple and straightforward!

Even though modem blood transfusion is extremely safe, problems remain. The potential for these problems increases with the number of transfusions.

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BMC Pregnancy and Childbirth

Table of Contents

This article has Open Peer Review reports available.

A criterion audit of women’s awareness of blood transfusion in pregnancy

  • M Khadra 1Email author ,
  • Claire Rigby 2 ,
  • Peter Warren 3 ,
  • Nicola Leighton 1 and
  • Richard Johanson 1

© Khadra et al; licensee BioMed Central Ltd. 2002

Received: 25 February 2002

Accepted: 25 September 2002

Published: 25 September 2002

Background

In the Confidential Enquiry into Maternal Deaths (CEMD) Report, the very high risk of mortality in women who refuse blood transfusions is highlighted. The objectives were to establish current knowledge about, and views of transfusion in our pregnant population and to establish the level of compliance with the set audit standard.

Questionnaire survey of 228 women, including both high and low risk pregnancies, attending ante-natal clinic between 2–9 May 2000 at the North Staffordshire Maternity Hospital, Stoke on Trent.

The response rate was 100%. Only 43% were aware of the possible need for blood transfusion in pregnancy. If a blood transfusion was required, 92% stated that they would accept a blood transfusion in pregnancy. Four percent stated that they would not accept a transfusion because of religious reasons and risk of infection and the remaining four percent did not declare a reason.

Conclusions

This short survey identified that 57% of women were not aware of the possible need for blood transfusion during pregnancy. There is a need for more information to be shared on this subject with all antenatal women. Women who would refuse a transfusion need to be identified at booking and be referred for counselling and a management plan made for pregnancy, labour and delivery.

Background

The vast majority of women accept blood transfusion if the clinical reasons for its necessity are fully and appropriately explained. However, a few women may continue to refuse transfusion because of specific personal or religious beliefs. The main group of women who may refuse for religious reasons are members of the Jehovah’s Witness faith. Jehovah’s Witnesses interpret a Biblical injunction [ 1 ] as meaning that the transfusion of whole blood, or its primary components, is prohibited, even if considered life-saving.

Worldwide there are 6 million Jehovah’s Witnesses [ 2 ] with 125,000 in the United Kingdom. In our district, North Staffordshire, there are 3,000 baptised Jehovah’s Witnesses of whom 400–500 are women that may present annually to the Obstetrics & Gynaecology department.

Jehovah’s Witnesses will not accept transfusions of whole blood, packed red cells, white cells, plasma, and platelets [ 3 ]. However, Jehovah’s Witnesses will accept non blood products such as Ringer’s lactate, normal saline, hypertonic saline, dextran, gelatine (gelofusine/haemaccel), and hetastarch [ 3 ].

Matters of patient choice include immunogloulins, clotting factors, albumin, dialysis, intra-operative cell salvage, haemodilution, and organ transplant [ 3 ].

In the CEMD the very high risk of mortality in women who refuse blood transfusion was highlighted [ 4 ]. The death rate in this group was 1 per 1,000 maternities compared with an expected incidence of less than 1 per 100, 000 maternities. A survey of 147 labour wards in the United Kingdom found only two units had recommendations for the management of women who refuse blood transfusion [ 5 ].

Within the North Staffordshire ASQUAM (Achieving Sustainable Quality in Maternity) Programme we have focused on improving the management of women with massive obstetric haemorrhage. A number of areas have been addressed, including the development of a protocol for the management of women who refuse blood transfusion. We therefore undertook an audit at the North Staffordshire Maternity Unit, to establish current knowledge about, and views of transfusion in our pregnant population.

We also wished to establish the level of compliance with the following audit standard:-

“All women should be asked at booking if they would have a blood transfusion. If not, they should be referred for counselling and a management plan made for pregnancy, labour and delivery” [ 4 ].

Two hundred and twenty eight women, of both high risk and low risk pregnancies, attending the ante-natal clinic at North Staffordshire Hospital (NHS) Trust during the period 2–9 May 2000 were asked to complete a questionnaire regarding blood transfusion.

All 228 women surveyed responded to the questionnaire:-

Forty eight percent (110) were first time mothers and 52% (117) had already had children. Of the 117 with children, 7% (8) had a blood transfusion in a previous pregnancy. Over 57% (129) were not aware of the possible need for blood transfusion during pregnancy.

Those who were aware of the possible need for blood transfusion during pregnancy had used their General Practitioner, family and friends and the media for information about this.

Ninety two percent (210) stated that they would have a blood transfusion if required. Religious reasons and risk of infection were stated as to why the 4% (9) would not accept a blood transfusion during pregnancy and 4% (9) did not declare a reason. Ninety two percent (209) stated that they thought that mothers-to-be should be provided with more information about this very unusual complication of pregnancy.

Discussion

This short survey identified that 57% of pregnant women were not aware of the possible need for blood transfusion during pregnancy. However, 92% stated that they thought that mothers-to-be should be provided with more information about this very unusual complication of pregnancy. Although the survey only sampled 228 women, it was adequate enough to give an insight into the need to identify women who refuse blood transfusion. Four percent stated that they would not accept a transfusion and this would be equivalent to approximately 200–300 women/year in our Unit. We feel that all units in the UK should include routine questions to identify women at booking who would refuse blood transfusion, if required. If they have concerns, they should be referred for counselling and a management plan should be made for pregnancy, labour and delivery. These issues and suggested guidelines were highlighted in the CEMD 1993–1996 [ 4 ].

Our Unit, together with the Hospital Liaison Committee for Jehovah’s Witnesses, have completed a Unit guideline for the management of women who refuse blood transfusion in pregnancy whether it be for religious or other personal reasons. An information pack and consent form is also included (available on request from the author). This will be given to the patient at booking and the consent form to be signed at some point during the antenatal period.

The guideline covers areas of consent and communication with various disciplines including a Consultant Haematologist and the anaesthetic team during the booking and antenatal period. It also covers the management of haemorrhage during the antenatal, intrapartum and post partum periods. Some of these strategies are outlined in attachment 1 (please see additional file 1 ).

There are a number of strategies recommended for avoiding and controlling haemorrhage and anaemia without blood transfusion. These are general principles of non-blood management which include adequate preoperative preparation, use of surgical and anaesthetic techniques to limit blood loss, non-blood volume expanders, haemostatic agents for bleeding/clotting problems, surgical haemorrhage/shock, obstetric haemorrhage, and therapeutic agents and techniques for managing anaemia [ 6 ] (please see additional file 2 : Leaflet).

Conclusion

This audit was undertaken almost 2 years ago which would be considered as one of the limitations of these results. However, we are currently reauditing this criteria following the introduction of our departmental guideline for the management of women refusing blood transfusion. We are not aware of a previously conducted audit in the UK. The aim of our study is to encourage other units to undertake similar audits in their department as well as to prepare local guidelines for the management of these women who have been highlighted in the CEMD due to their increased maternal mortality and morbidity.

Author contributions

MK undertook literature search, drafted the manuscript. CR devised the data collection form, data entry, analysis and presentation of data. PW advised on aspects of management, reviewed the manuscript. NL perfomed the analysis and presentation of data, manuscript handling. RBJ conceived the audit question, reviewed the article.

All authors read and approved the final manuscript.

По материалам:

Blood Transfusions During Pregnancy

http://www.pregnancy-bliss.co.uk/SCD.html

http://ias.geosys.ru/class/why-give-lasix-during-blood-transfusion.html

http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-2-7

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