TY - JOUR
T1 - Risk factors for peripartum blood transfusion in South Africa
T2 - a case-control study
AU - for the South Africa Program of the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)
AU - Bloch, Evan M.
AU - Ingram, Charlotte
AU - Hull, Jennifer
AU - Fawcus, Susan
AU - Anthony, John
AU - Green-Thompson, Randolph
AU - Crookes, Robert L.
AU - Ngcobo, Solomuzi
AU - V. Creel, Darryl
AU - Courtney, Lauren
AU - Bellairs, Greg R.M.
AU - Murphy, Edward L.
N1 - Funding Information:
From the 1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2Blood Systems Research Institute, San Francisco, California; the 3South African National Blood Service, Johannesburg, South Africa; the 4South African Bone Marrow Registry, Cape Town, South Africa; the 5Department of Obstetrics and Gynecology, Chris Hani Baragwanath Hospital, Soweto, South Africa; the 6Department of Obstetrics and Gynecology, Mowbray Maternity Hospital; and the 7Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa; the 8Department of Obstetrics and Gynecology, King Edward Hospital, Durban, South Africa; 9Cryo-Save, Pretoria, South Africa; 10RTI international, Rockville, Maryland; the 11Western Province Blood Transfusion Service, Cape Town, South Africa; and the 12Departments of Laboratory Medicine and Epidemiology/ Biostatistics, University of California San Francisco, San Francisco, California. Address reprint requests to: Dr Evan M. Bloch, Assistant Professor, Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Carnegie 446 D1, Baltimore, MD 21287-6667; e-mail: ebloch2@jhmi.edu The work was supported by contracts from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (Recipient Epidemiology and Donor Evaluation Study-III contracts HHSN268201100009I, HHSN268201100002I, HHSN26800002, and HHSN26800003).
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. The Recipient Epidemiology and Donor Evaluation Study-III, International Program in South Africa, is the responsibility of the following: University of California, San Francisco; South African National Blood Service; RTI International; and the National Heart, Lung, and Blood Institute, NIH. EMB, RC, and ELM conceived the study and developed the methodology in communication with the clinical investigators (JH, SF, JA, and RGT). CI together with SN 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 were also actively involved in interpretation of results and manuscript preparation. GRMB was involved in coordination of the Cape Town sites; he also contributed to manuscript preparation. LC was responsible for training and logistic coordination. DC was primarily responsible for data analysis and statistical support. EMB and ELM were primarily responsible for a first-draft manuscript. All authors contributed to subsequent drafting and revising the final manuscript.
Publisher Copyright:
© 2018 AABB
PY - 2018/9
Y1 - 2018/9
N2 - BACKGROUND: Obstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high-income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion. STUDY DESIGN AND METHODS: A case-control study was conducted at four large South African hospitals. Transfused peripartum women (cases) and nontransfused controls were stratum matched 1:2 by hospital and delivery date. Data on obstetric, transfusion, and human immunodeficiency virus (HIV) history were abstracted from medical records. Blood was obtained for laboratory evaluation. We calculated unadjusted and adjusted odds ratios (ORs) for transfusion using logistic regression. RESULTS: A total of 1200 transfused cases and 2434 controls were evaluated. Antepartum hemorrhage (OR, 197.95; 95% confidence interval [CI], 104.27-375.78), hemorrhage with vaginal delivery (OR, 136.46; 95% CI, 75.87-245.18), prenatal anemia (OR, 22.76; 95% CI, 12.34-41.93 for prenatal hemoglobin level < 7 g/dL), and failed access to prenatal care (OR, 6.71; 95% CI, 4.32-10.42) were the major risk factors for transfusion. Platelet (PLT) count (ORs, 4.10, 2.66, and 1.77 for ≤50 × 109, 51 × 109-100 × 109, and 101 × 109-150 × 109 cells/L, respectively), HIV infection (OR, 1.29; 95% CI, 1.02-1.62), and admitting hospital (twofold variation) were also associated with transfusion. Mode of delivery, race, age category, gravidity, parity, gestational age, and birthweight were not independently associated with transfusion. CONCLUSION: Major risk factors of peripartum transfusion in South Africa, namely, prenatal anemia and access to prenatal care, may be amenable to intervention. HIV infection and moderately low PLT count are novel risk factors that merit further investigation.
AB - BACKGROUND: Obstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high-income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion. STUDY DESIGN AND METHODS: A case-control study was conducted at four large South African hospitals. Transfused peripartum women (cases) and nontransfused controls were stratum matched 1:2 by hospital and delivery date. Data on obstetric, transfusion, and human immunodeficiency virus (HIV) history were abstracted from medical records. Blood was obtained for laboratory evaluation. We calculated unadjusted and adjusted odds ratios (ORs) for transfusion using logistic regression. RESULTS: A total of 1200 transfused cases and 2434 controls were evaluated. Antepartum hemorrhage (OR, 197.95; 95% confidence interval [CI], 104.27-375.78), hemorrhage with vaginal delivery (OR, 136.46; 95% CI, 75.87-245.18), prenatal anemia (OR, 22.76; 95% CI, 12.34-41.93 for prenatal hemoglobin level < 7 g/dL), and failed access to prenatal care (OR, 6.71; 95% CI, 4.32-10.42) were the major risk factors for transfusion. Platelet (PLT) count (ORs, 4.10, 2.66, and 1.77 for ≤50 × 109, 51 × 109-100 × 109, and 101 × 109-150 × 109 cells/L, respectively), HIV infection (OR, 1.29; 95% CI, 1.02-1.62), and admitting hospital (twofold variation) were also associated with transfusion. Mode of delivery, race, age category, gravidity, parity, gestational age, and birthweight were not independently associated with transfusion. CONCLUSION: Major risk factors of peripartum transfusion in South Africa, namely, prenatal anemia and access to prenatal care, may be amenable to intervention. HIV infection and moderately low PLT count are novel risk factors that merit further investigation.
UR - http://www.scopus.com/inward/record.url?scp=85050918995&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050918995&partnerID=8YFLogxK
U2 - 10.1111/trf.14772
DO - 10.1111/trf.14772
M3 - Article
C2 - 29989178
AN - SCOPUS:85050918995
SN - 0041-1132
VL - 58
SP - 2149
EP - 2156
JO - Transfusion
JF - Transfusion
IS - 9
ER -