Strategies to reduce blood product utilization in obstetric practice.
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.