Research Article
Üçüncü Basamak Hastanede Obstetrik ve Jinekolojik Nedenlerle Yapılan Kan Transfüzyonlarının Değerlendirilmesi
Abstract
Kan transfüzyonu; kan bileşenlerinin ve koagülasyon faktör konsantrelerinin hastaya verilmesi olarak tanımlamaktadır. 20 ile 35 yaşları arasındaki transfüzyonların yaklaşık yarısı, Obstetri ve Jinekoloji kliniklerinde yapılmaktadır. Muğla Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde, Ocak 2014-Aralık 2018 tarihleri arasında hastanemizde kan transfüzyonu yapılan 137 hastanın elektronik dosya kayıtları incelendi. Demografik bilgileri, Hemoglobin ve Hematokrit (transfüzyon öncesi ve sonrası) değerleri, uygulanan kan ürünleri ve miktarı kaydedildi. Kan transfüzyonu uygulanan hastaların 79’u obstetrik, 58’i jinekolojik hastadır. Obstetrik vakalarda en sık sezaryen sonrası kan transfüzyonu uygulanmıştır (%56.6). Transfüzyon nedenleri arasında en sık rastlanan anemi nedeni demir eksikliği anemisi 43 (%54) dir. Sonraki nedenler ise; 10 (%12.6)’unuda Dilatasyon/Küretaj (D/C) sonrası gelişen anemi, 5 (%6.32)’inde uterin atoni sonrası gelişen anemi şeklinde sıralanmaktadır. Jinekolojik nedenler ile transfüzyon uygulanan 58 hastanın; 12 (%20.68)’sine menometroraji tanısı ile tanısal amaçlı D/C, total abdominal histerektomi, 10 (%17.24)’u myomektomi, 9 (%15.51)’u total laparoskopik histerektomi, 5 (%8.62)’i ürojinekolojik cerrahi, laparoskopik kistektomi yapılmış, menometroraji tanısı ile medikal tedavi almıştır. Kan ve kan ürünlerinin hazırlanması ve kullanılması, Kadın Hastalıkları ve Doğum Uzmanı ve Hematolog başta olmak üzere birçok branşı kapsayacak şekilde multidisipliner yaklaşılmalıdır. Gebelere ve cerrahi geçirecek hastalara, anemi proflaksisi önceden başlanarak post-operatif transfüzyon azaltılmalıdır. Transfüzyon sırasında ve sonrasında oluşabilecek komplikasyonlardan kaçınmak için gereksiz transfüzyonlardan kaçınılmalıdır.
References
- 1. Ayoğlu H. Bir Üniversite Hastanesinde Peroperatif Kan Transfüzyon Uygulamalarını Etkileyen Faktörler. GKDA Derg. 2019;25(4):229-41.
- 2. Atamer T. Kan transfüzyonunun tarihçesi. 35. Ulusal Hematoloji Kongresi. Antalya.2009;35:7-10.
- 3. Schantz-Dunn J, Nawal M. The use of blood in obstetrics and gynecology in the developing world. Rev Obstet Gynecol. 2011;4:86.
- 4. Wells A, Mounter P, Chapman C, et al. Where does blood go? Prospective observational study of red cell transfusion in north England. Bmj. 2002;325:803.
- 5. Secen Eİ, Sargın MA, Çamurşen E, et al. Peripartum ve Postpartum Kan Transfüzyonu Yapılan Hastalarda Klinik Deneyimlerimiz. Zeynep Kamil Tıp Bült. 2020;51:31-4.
- 6. Çakmak B, Gülücü S, Nacar MC, et al. Obstetrikte Kan Transfüzyonu: Bir Üniversite Hastanesi Klinik Deneyimi. Gaziosmanpaşa Üni Tıp Fak Derg. 2013;5:140-4.
- 7. Stanhiser J, Chagin K, Jelovsek JE. A model to predict risk of blood transfusion after gynecologic surgery. Am J Obstet Gynecol. 2017;216:506. e501-506. e514.
- 8. Kıncı MF, Paskal EK, Saruhan E, et al. Prevalence of Anemia: Figures at the Time of Pregnancy Detection in Our Hospital. J Clin Obstet Gynecol. 2020;30:141-5.
- 9. Richards T, Musallam KM, Nassif J, et al. Impact of preoperative anaemia and blood transfusion on postoperative outcomes in gynaecological surgery. PloS one. 2015;10:e0130861.
- 10. Günaydın B, Işık G, Bağcaz S, et al. Jinekolojik ve Obstetrik Cerrahi Hastalarında Preoperatif Anemi Tedavisinin Etkilerinin Retrospektif Değerlendirmesi. Turk J Anaesthesiol Reanim.2020. 10.5152/TJAR2020.484.
- 11. Obstetricians ACo, Gynecologists. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006;108:1039-47.
- 12. Balki M, Dhumne S, Kasodekar S, et al. Blood transfusion for primary postpartum hemorrhage: a tertiary care hospital review. J Obstet Gynaecol Can. 2008;30:1002-7.
- 13. Yüksel H, Odabaşı AR, Kafkas S, et al. Kadın hastalıkları ve doğum servislerinde kan kullanımı. ADÜ Tıp Fak Derg. 2006;7(3):7-11.
- 14. Stones RW, Paterson CM, Saunders NJS. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48:15-8.
- 15. Thurn L, Wikman A, Westgren M, et al. Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population‐based cohort study. BJOG. 2019;126:1577-86.
- 16. Madhushree D, Metgud MC, Patil K. Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study. Indian J Health Sci Biomed Res (KLEU). 2018;11(2):116-20.
- 17. Otton G, Mandapati S, Streatfeild K, et al. Transfusion rate associated with hysterectomy for benign disease. Aust N Z J Obstet Gynaecol. 2001;41:439-42.
- 18. Ng SP. Blood transfusion requirements for abdominal hysterectomy: 3‐year experience in a district hospital (1993–1995). Aust N Z J Obstet Gynaecol. 1997;37:452-7.
- 19. Vasudev R, Sawhney V, Dogra M, et al. Transfusion-related adverse reactions: From institutional hemovigilance effort to National Hemovigilance program. Asian J Transfus Sci. 2016;10(1):31-6.
- 20. Neb H, Zacharowski K, Meybohm P. Strategies to reduce blood product utilization in obstetric practice. Curr Opin Anaesthesiol. 2017;30:294-9.
Evaluation of Blood Transfusions Performed for Obstetric and Gynecological Reasons in the Tertiary Hospital
Abstract
Blood transfusion is defined as the delivery of blood components and coagulation factor concentrates to a patient. About half of transfusions between the ages of 20 and 35 are performed in Obstetrics and Gynecology Clinics. Electronic file records of 137 patients who underwent blood transfusion in Muğla Training and Research Hospital, Gynecology and Obstetrics Clinic between January 2014 and December 2018 were reviewed retrospectively. The demographic information of the patients, Hgb and Hct (before and after transfusion) values, and applied blood products and their amount were recorded. Of the patients who received blood transfusion, 79 were obstetric and 58 were gynecological patients. In obstetric cases, blood transfusion was most frequently performed after cesarean section (56.6%). Among the causes of transfusion, 43 (54%) patients had iron deficiency anemia, 10 (12.6%) patients had anemia after Dilatation/Curettage (D/C), and 5 (6.32%) patients had uterine atony. Diagnostic D/C and total abdominal hysterectomy were performed in 12 (20.68%) of 58 patients, who were transfused for gynecological reasons, with the diagnosis of menometrorrhagia, while myomectomy was performed in 10 of these patients (17.24%), total laparoscopic hysterectomy was performed in 9 (15.51%) patients, urogynecological surgery and laparoscopic cystectomy were performed in 5 (8.62%) patients, and medical treatment was given with the diagnosis of menometrorrhagia. The preparation and use of blood and blood products should be approached in a multidisciplinary manner, covering many branches, especially Gynecology and Obstetrics and Hematology. Anemia prophylaxis should be initiated beforehand and post-operative transfusion should be reduced in pregnant women and patients who will undergo surgery. Unnecessary transfusions should be avoided in order to avoid complications that may occur during and after transfusion.
References
- 1. Ayoğlu H. Bir Üniversite Hastanesinde Peroperatif Kan Transfüzyon Uygulamalarını Etkileyen Faktörler. GKDA Derg. 2019;25(4):229-41.
- 2. Atamer T. Kan transfüzyonunun tarihçesi. 35. Ulusal Hematoloji Kongresi. Antalya.2009;35:7-10.
- 3. Schantz-Dunn J, Nawal M. The use of blood in obstetrics and gynecology in the developing world. Rev Obstet Gynecol. 2011;4:86.
- 4. Wells A, Mounter P, Chapman C, et al. Where does blood go? Prospective observational study of red cell transfusion in north England. Bmj. 2002;325:803.
- 5. Secen Eİ, Sargın MA, Çamurşen E, et al. Peripartum ve Postpartum Kan Transfüzyonu Yapılan Hastalarda Klinik Deneyimlerimiz. Zeynep Kamil Tıp Bült. 2020;51:31-4.
- 6. Çakmak B, Gülücü S, Nacar MC, et al. Obstetrikte Kan Transfüzyonu: Bir Üniversite Hastanesi Klinik Deneyimi. Gaziosmanpaşa Üni Tıp Fak Derg. 2013;5:140-4.
- 7. Stanhiser J, Chagin K, Jelovsek JE. A model to predict risk of blood transfusion after gynecologic surgery. Am J Obstet Gynecol. 2017;216:506. e501-506. e514.
- 8. Kıncı MF, Paskal EK, Saruhan E, et al. Prevalence of Anemia: Figures at the Time of Pregnancy Detection in Our Hospital. J Clin Obstet Gynecol. 2020;30:141-5.
- 9. Richards T, Musallam KM, Nassif J, et al. Impact of preoperative anaemia and blood transfusion on postoperative outcomes in gynaecological surgery. PloS one. 2015;10:e0130861.
- 10. Günaydın B, Işık G, Bağcaz S, et al. Jinekolojik ve Obstetrik Cerrahi Hastalarında Preoperatif Anemi Tedavisinin Etkilerinin Retrospektif Değerlendirmesi. Turk J Anaesthesiol Reanim.2020. 10.5152/TJAR2020.484.
- 11. Obstetricians ACo, Gynecologists. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006;108:1039-47.
- 12. Balki M, Dhumne S, Kasodekar S, et al. Blood transfusion for primary postpartum hemorrhage: a tertiary care hospital review. J Obstet Gynaecol Can. 2008;30:1002-7.
- 13. Yüksel H, Odabaşı AR, Kafkas S, et al. Kadın hastalıkları ve doğum servislerinde kan kullanımı. ADÜ Tıp Fak Derg. 2006;7(3):7-11.
- 14. Stones RW, Paterson CM, Saunders NJS. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48:15-8.
- 15. Thurn L, Wikman A, Westgren M, et al. Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population‐based cohort study. BJOG. 2019;126:1577-86.
- 16. Madhushree D, Metgud MC, Patil K. Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study. Indian J Health Sci Biomed Res (KLEU). 2018;11(2):116-20.
- 17. Otton G, Mandapati S, Streatfeild K, et al. Transfusion rate associated with hysterectomy for benign disease. Aust N Z J Obstet Gynaecol. 2001;41:439-42.
- 18. Ng SP. Blood transfusion requirements for abdominal hysterectomy: 3‐year experience in a district hospital (1993–1995). Aust N Z J Obstet Gynaecol. 1997;37:452-7.
- 19. Vasudev R, Sawhney V, Dogra M, et al. Transfusion-related adverse reactions: From institutional hemovigilance effort to National Hemovigilance program. Asian J Transfus Sci. 2016;10(1):31-6.
- 20. Neb H, Zacharowski K, Meybohm P. Strategies to reduce blood product utilization in obstetric practice. Curr Opin Anaesthesiol. 2017;30:294-9.
There are 20 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Original Article |
| Authors | |
| Publication Date | December 30, 2022 |
| Submission Date | September 30, 2021 |
| Published in Issue | Year 2022 Volume: 9 Issue: 3 |
