Blood Transfusion

Green-top Guideline

No. 47

December 2007

Minor revisions July 2008

BLOOD TRANSFUSION IN OBSTETRICS

This is the first edition of this guideline.

1.

Purpose and scope

Obstetric conditions associated with the need for blood transfusion may lead to morbidity and mortality if not

managed correctly. The increasingly important issues in blood transfusion are adverse events associated with

transfusion, including potential infection and potential transmission of prions, rising costs and the possible

future problems of availability. Unfortunately, information from randomised controlled trials to inform best

practice is largely unavailable in the discipline of blood transfusion.

The aim of this guideline is to offer guidance about the appropriate use of blood products that neither

compromises the affected woman nor exposes her to unnecessary risk. Strategies to maximise the

haemoglobin (Hb) level at delivery as well as to minimise blood loss are also discussed. It is envisaged that

this guideline will be incorporated into a protocol for each unit to disseminate locally.

2.

Background

Obstetric haemorrhage remains a major cause of maternal mortality in the UK, with substandard management

identified as a contributor in 80% of the cases.1 It is estimated that there are more than 4000 cases of severe

haemorrhage each year in the UK. The majority of these cases will need blood transfusion.

Retrospective analyses of the clinical scenarios often criticise the employment of blood transfusion

as ‘too little, too late’. Women at high risk of losing greater than 1000 ml should be strongly advised

to deliver in a setting where blood transfusion and intensive care facilities are available.1,2

Evidence

level III

Blood transfusion may be a life-saving procedure but it is not without risk. Recipients may rarely develop

transfusion-transmitted infection as well as suffer immunological sequelae such as red cell alloimmunisation.

The major risk of...