Retrospective surveys of obstetric red cell transfusion practice in the UK and USA

Objective: To examine whether professional guidance promoting a policy of restrictive blood transfusion is being followed. Methods: A retrospective analysis of post-delivery transfusion data from 17 maternity units in the UK (1988–2000) was undertaken. Additionally, an audit was performed of women receiving one or two units of red cells 6–24 hours after delivery at three centers in the UK and USA in 2013–2016. Results: Between 1988 and 2000, 4700 women received one or two transfusions: 303 (6.4%) received one unit and 4397 (93.6%) received two. Median estimated blood loss (EBL) was similar in both groups (600 mL [IQR 400–1000] vs 700 mL [IQR 400–1000], respectively; P=0.862]. Between 2013 and 2016, 41, 22, and 64 women received one or two units during transfusion at centers A, B, and C, respectively. Two units were transfused for 40 (97.6%) of the women in center A, 21 (95.5%) at center B, and 58 (90.6%) at center C. Median EBL was similar, irrespective of whether one or two units were given. Conclusion: Current transfusion practice deviates from evidence-based guidelines. Either by default or longstanding tradition, more women receive two rather than one unit despite similar EBL.