Antenatal blood transfusion in South Africa: indications and practice in a high-HIV-prevalence setting

for the NHLBI REDS-III South Africa Program

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalTransfusion
DOIs
StateAccepted/In press - Jan 1 2020

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South Africa
Blood Transfusion
HIV
Anemia
Ectopic Pregnancy
Hemorrhage
Gestational Age
HIV Infections
Pregnancy
Third Pregnancy Trimester
First Pregnancy Trimester
Obstetrics
Medical Records
Pregnant Women
Hemoglobins
Epidemiology
Blood Platelets
Cross-Sectional Studies
Erythrocytes
History

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Antenatal blood transfusion in South Africa : indications and practice in a high-HIV-prevalence setting. / for the NHLBI REDS-III South Africa Program.

In: Transfusion, 01.01.2020.

Research output: Contribution to journalArticle

@article{f2b88c257ed84bc998e4cb2bfb8bac4e,
title = "Antenatal blood transfusion in South Africa: indications and practice in a high-HIV-prevalence setting",
abstract = "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.",
author = "{for the NHLBI REDS-III South Africa Program} and Bloch, {Evan M.} and Jennifer Hull and Randolph Green-Thompson and Charlotte Ingram and Crookes, {Robert L.} and Susan Fawcus and John Anthony and Lauren Courtney and Nareg Roubinian and Adam Jauregui and Hilton, {Joan F.} and Murphy, {Edward L.}",
year = "2020",
month = "1",
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doi = "10.1111/trf.15661",
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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.

PY - 2020/1/1

Y1 - 2020/1/1

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

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