New Green-top guidelines on blood transfusions

The RCOG have released a new Green-top guideline on the use of blood transfusions. Obstetric haemorrhage is one of the major causes of maternal mortality in the UK. It is estimated that there are more than 4,000 cases of severe haemorrhage each year in the UK; the majority of these women will need a blood transfusion. The latest guidance acknowledges that these transfusions can be a life-saving procedure, but that the risks must be managed correctly.

The key recommendations from the guidelines include measures to identify anaemia early and therefore reduce the need for transfusions:

Pregnant women should be screened for anaemia at booking – ideally by 10 weeks’ gestation – and at 28 weeks.

Women with multiple pregnancies should have an additional full blood count done at 20 to 24 weeks.

Oral iron should be the preferred first line treatment for iron deficiency in order to reduce the risk of needing a blood transfusion in labour.

Women should receive information about factors affecting the absorption of dietary iron and how to improve dietary iron intake

It also provides guidelines for managing obstetric haemorrhage:

All women should have their blood group and antibodies status checked at booking and at 28 weeks’ gestation, in case they need a blood transfusion during labour.

Pregnant women at high risk of haemorrhage should be strongly advised to deliver in a hospital setting where transfusion and intensive care facilities are available, as well as access to specialist consultant care.

All obstetric units should have a clear local protocol on how to manage major obstetric haemorrhage, which should include early involvement of a multidisciplinary team.

Dr Manish Gupta, Chair of the RCOG Guideline Committee said: “Blood transfusion may be a life-saving procedure, but it is not without risk. Rarely, recipients may develop transfusion-transmitted infection or have a negative reaction to it. The major risk, however, is of a patient receiving an incorrect blood component.”

The guidelines can be viewed here

A RCOG summary here

RCM report here