Single vs. two-unit transfusion in postpartum anemia: identifying predictors in a retrospective cohort.
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| Titel: | Single vs. two-unit transfusion in postpartum anemia: identifying predictors in a retrospective cohort. |
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| Autoren: | Ben David C; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel., Or I; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Iluz R; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel., Khatib N; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Ginsberg Y; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Beloosesky R; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Weiner Z; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Solt I; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Vitner D; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel., Bonstein L; Blood Bank and Platelet Immunology Laboratories, Rambam Health Care Campus, Haifa, Israel., Zipori Y; Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.; Ruth & Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel. |
| Quelle: | The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2025 Dec; Vol. 38 (1), pp. 2582943. Date of Electronic Publication: 2025 Nov 09. |
| Publikationsart: | Journal Article; Comparative Study |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Informa Healthcare Country of Publication: England NLM ID: 101136916 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-4954 (Electronic) Linking ISSN: 14764954 NLM ISO Abbreviation: J Matern Fetal Neonatal Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: London : Informa Healthcare Original Publication: Boca Raton : Parthenon Pub. Group, c2002- |
| MeSH-Schlagworte: | Anemia*/therapy , Erythrocyte Transfusion*/methods , Erythrocyte Transfusion*/statistics & numerical data , Postpartum Hemorrhage*/therapy , Puerperal Disorders*/therapy, Humans ; Female ; Retrospective Studies ; Adult ; Pregnancy ; Risk Factors |
| Abstract: | Objective: Obstetricians have debated the use of single or two-unit protocols in women presenting with post-partum anemia (PPA). A recent trial showed that implementing the single unit approach prevented second unit transfusion in 80% of patients. However, the risk factors for identifying patients who may benefit from up-front two-unit approach has yet to be defined. Methods: Retrospective cohort study performed during 2013-2023. The study group included women with PPA who received transfusion of packed red blood cells (pRBCs). Patients who were hemodynamically unstable were excluded from the study. The groups were divided into patients who received single versus two units of pRBCs. The primary outcome was to identify risk factors that may benefit from an up-front two-unit protocol. Results: The final analysis included 368 women who received single-unit compared with 317 women receiving two-unit 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. Conclusion: In our cohort, no independent predictors for requiring two units were identified, highlighting the variability in clinical decision-making and supporting reassessment after each transfusion. Following these guidelines will help obstetricians reduce costs and morbidity associated with pRBCs transfusion. |
| Contributed Indexing: | Keywords: Postpartum; anemia; hemoglobin; packed red blood cells; transfusion |
| Entry Date(s): | Date Created: 20251109 Date Completed: 20251112 Latest Revision: 20251112 |
| Update Code: | 20251113 |
| DOI: | 10.1080/14767058.2025.2582943 |
| PMID: | 41207783 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Objective: Obstetricians have debated the use of single or two-unit protocols in women presenting with post-partum anemia (PPA). A recent trial showed that implementing the single unit approach prevented second unit transfusion in 80% of patients. However, the risk factors for identifying patients who may benefit from up-front two-unit approach has yet to be defined.<br />Methods: Retrospective cohort study performed during 2013-2023. The study group included women with PPA who received transfusion of packed red blood cells (pRBCs). Patients who were hemodynamically unstable were excluded from the study. The groups were divided into patients who received single versus two units of pRBCs. The primary outcome was to identify risk factors that may benefit from an up-front two-unit protocol.<br />Results: The final analysis included 368 women who received single-unit compared with 317 women receiving two-unit 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.<br />Conclusion: In our cohort, no independent predictors for requiring two units were identified, highlighting the variability in clinical decision-making and supporting reassessment after each transfusion. Following these guidelines will help obstetricians reduce costs and morbidity associated with pRBCs transfusion. |
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| ISSN: | 1476-4954 |
| DOI: | 10.1080/14767058.2025.2582943 |