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Clinical Obstetrics

Poster Session 4

(1159) Reducing blood transfusion administration by introducing a structured intravenous iron protocol for maternal postpartum anemia

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

To investigate the effect of implementation of an institutional protocol targeting postpartum anemia with intravenous iron sucrose infusion (Venofer), on the use of red blood cell transfusions (RBCT).

Study Design:

A detailed structured protocol for managing maternal anemia was introduced starting July 2021 in a single tertiary center based on different hemoglobin (Hb) concentrations, symptoms, and vital signs. The protocol aimed to educate and encourage the routine use of Venofer instead of RBCT in patients with Hb concentrations between 7-10 g/dL. 

A comparative analysis was conducted across two distinct time frames: the year preceding the protocol implementation (July 2020 to June 2021), a transitional period (which was excluded from analysis), and the year of protocol implementation (January 2022 to December 2022). All maternal cases that underwent RBCT were enrolled in the study.

Results:

Over the course of 24 months in this study, a total of 94 women underwent RBCT prior to the introduction of the protocol, with this number decreasing to 73 after protocol implementation. A comparative analysis between women who received RBCT prior to and following protocol implementation, revealed that the proportion of women receiving RBCT for Hb levels between 8-10 g/dl, dropped from 41.5% to 13.7%. The average Hb for initiating RBCT was lowered from 7.9 to 7.2 following the introduction of the protocol (pv< .001). Moreover, there was a significant decrease in RBCT use in each Hb concentration separately (Figure 1). Furthermore, after adjusting for the difference in the number of deliveries during each study period, there was a notable 41% reduction in the utilization of RBCT in the year after protocol implementation, yielding an odds ratio of 0.59 [CI: 0.44-0.79] of receiving RBCT.

Conclusion:

The implementation of a simple management protocol targeting postpartum anemia using Venofer was associated with a significant 41% decrease in the utilization of RBCT in our center.