TY - JOUR
T1 - Antenatal blood transfusion in South Africa
T2 - indications and practice in a high-HIV-prevalence setting
AU - for the NHLBI REDS-III South Africa Program
AU - Bloch, Evan M.
AU - Hull, Jennifer
AU - Green-Thompson, Randolph
AU - Ingram, Charlotte
AU - Crookes, Robert L.
AU - Fawcus, Susan
AU - Anthony, John
AU - Courtney, Lauren
AU - Roubinian, Nareg
AU - Jauregui, Adam
AU - Hilton, Joan F.
AU - Murphy, Edward L.
N1 - Funding Information:
The authors thank the research nurses Srs. Hawa Khan, Ntombifuthi Makhanya, Ellen Makhale, Lily Ntombemhle Shabangu, and Susan Maimela for their invaluable contribution to the study. We are also grateful to the medical and nursing personnel at Chris-Hani Baragwanath Hospital, King Edward VIII Hospital, Mowbray Maternity Hospital, and Groote Schuur Hospital for their support. EMB, RC, and ELM conceived the study and developed the methodology in communication with the South African clinical investigators (JH, SF, JA, and RGT). CI and RC oversaw the study in South Africa. Each of the clinical investigators (JH, SF, JA, and RGT) was responsible for activities at their individual hospital sites. They and NR were also actively involved in interpretation of results and manuscript preparation. LC was responsible for training and logistical coordination. JFH and AJ were primarily responsible for data analysis and statistical support. EMB and ELM were primarily responsible for drafting the manuscript, and all authors contributed to subsequent revisions.
Publisher Copyright:
© 2020 AABB
PY - 2020/3/1
Y1 - 2020/3/1
N2 - BACKGROUND: Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS: A cross-sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS: The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one-half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre- and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION: Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.
AB - BACKGROUND: Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS: A cross-sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS: The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one-half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre- and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION: Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.
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U2 - 10.1111/trf.15661
DO - 10.1111/trf.15661
M3 - Article
C2 - 31909499
AN - SCOPUS:85077906117
VL - 60
SP - 479
EP - 487
JO - Transfusion
JF - Transfusion
SN - 0041-1132
IS - 3
ER -