The influence of hematological profiles on the transfusion management and mortality risk of mothers presenting to the obstetric unit of a South African tertiary medical facility

Michael Linström; Ernest Musekwa; Erica-Mari Nell; Liesl de Waard; Zivanai Chapanduka

doi:10.1111/trf.17849

The influence of hematological profiles on the transfusion management and mortality risk of mothers presenting to the obstetric unit of a South African tertiary medical facility

Transfusion. 2024 Apr 25. doi: 10.1111/trf.17849. Online ahead of print.

Authors

Michael Linström^{1

2}, Ernest Musekwa^{1

2}, Erica-Mari Nell^{1

2}, Liesl de Waard³, Zivanai Chapanduka^{1

2}

Affiliations

¹ Division of Hematological Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.
² Division of Hematopathology, National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa.
³ Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.

PMID: 38661229
DOI: 10.1111/trf.17849

Abstract

Background: Laboratory results are frequently abnormal in pregnant mothers. Abnormalities usually relate to pregnancy or associated complications. Hematological abnormalities and age in pregnancy may increase the likelihood for transfusion and mortality.

Study design and methods: Hematological profiles and transfusion history of pregnant mothers presenting to a tertiary hospital, were evaluated over 2 years. Age, anemia, leukocytosis and thrombocytopenia were assessed for transfusion likelihood. Iron deficiency and coagulation were assessed in transfused patients. Anemia, leukocytosis, thrombocytopenia, human immunodeficiency virus (HIV) and transfusion were assessed for mortality likelihood.

Results: There were 12,889 pregnant mothers included. Mothers <19-years-old had the highest prevalence of anemia (31.5%) and proportion of transfusions (19%). The transfusion likelihood was increased in mothers with anemia (odds ratios [OR] = 6.41; confidence intervals at 95% [95% CI] 5.46-7.71), leukocytosis (OR = 2.35; 95% CI 2.00-2.76) or thrombocytopenia (OR = 2.71; 95% CI 2.21-3.33). Mothers with prolonged prothrombin times received twice as many blood products as their normal counterparts (p = .03) and those with iron deficiency anemia five times more blood products (p < .001). Increased likelihood for mortality was seen in patients with anemia (OR = 4.15, 95% CI 2.03-8.49), leukocytosis (OR = 2.68; 95% CI 1.19-6.04) and those receiving blood transfusion (OR = 3.6, 95% CI 1.75-7.47).

Discussion: Adolescence, anemia, leukocytosis and thrombocytopenia expose mothers to a high risk for transfusion and/or mortality. These risk factors should promptly trigger management and referral of patients. Presenting hematological profiles are strong predictors of maternal outcome and transfusion risk.

Keywords: hematological results and transfusion risk; maternal transfusion; maternal transfusion mortality risk; obstetric transfusion; pregnancy transfusion risk.