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Strategies to reduce blood product utilization in obstetric practice.

Current opinion in anaesthesiology
June 1, 2017
Holger Neb et al. (3 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the safety and efficacy of intravenous iron as a strategy to replenish iron stores and correct iron deficiency anemia in obstetric patients, particularly in the context of patient blood management.

Results Summary

The study found that intravenous iron is a safe and effective method for correcting pregnancy-related and hemorrhage-related iron deficiency anemia, supporting its use to increase peripartum hemoglobin levels. It also highlighted the potential of tranexamic acid and coagulation factor supplementation to reduce unnecessary blood loss and transfusions in obstetrics.

Population

Obstetric patients, particularly those undergoing cesarean section or experiencing peripartum hemorrhage.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (11)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Patient blood management (PBM)
increase
patient outcome and safety
patients in elective surgery and obstetrics
-
aims to improve
#1
Patient blood management (PBM)
decrease
the number of unnecessary RBC transfusions
patients in elective surgery and obstetrics
-
reducing
#2
Intravenous iron
increase
iron stores
patients with pregnancy-related and hemorrhage-related iron deficiency anemia
-
can be considered a safe, effective strategy to replenish
#3
Intravenous iron
decrease
both pregnancy-related and hemorrhage-related iron deficiency anemia
patients with pregnancy-related and hemorrhage-related iron deficiency anemia
-
to correct
#4
early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice
increase
management of coagulopathy
patients with peripartum hemorrhage
-
support
#5
autologous red cell blood salvage
decrease
blood product utilization
patients with cesarean section
-
may reduce
#6
Implementation of PBM in obstetric practice
decrease
blood loss
obstetric patients
-
offers large potential to reduce
#7
Implementation of PBM in obstetric practice
decrease
transfusion requirements of allogeneic blood products
obstetric patients
-
offers large potential to reduce
#8
Intravenous iron supplementation
increase
peripartum hemoglobin levels
peripartum patients
-
may be suggested to increase
#9
tranexamic acid and point-of-care-guided supplementation of coagulation factors
decrease
unnecessary blood loss
obstetric patients
-
are potent methods to reduce
#10
tranexamic acid and point-of-care-guided supplementation of coagulation factors
decrease
blood transfusions
obstetric patients
-
are potent methods to reduce
#11
Abstract

PURPOSE OF REVIEW: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. RECENT FINDINGS: PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. SUMMARY: Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.

Medical Subject Headings (MeSH)
AnemiaAnesthesia, ObstetricalBlood Coagulation Disorders, InheritedBlood Coagulation FactorsBlood Component TransfusionBlood Loss, SurgicalCesarean SectionEvidence-Based MedicineFemaleHemostaticsHumansIncidenceOperative Blood SalvageOxytocicsPoint-of-Care SystemsPostpartum HemorrhagePregnancyPregnancy Complications, Hematologic
Study Links
Quality Scores
Safety85
Efficacy80/10
Quality75/10
Citation Metrics
Total Citations9
Citations/Year1.1
Relative Citation Ratio0.66
NIH Percentile35.5%
Research Impact Scores
APT Score0.25
Weight Score1.80
Normalized Score0.81
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