The fifth in a series of six evidence-based patient blood management (PBM) guidelines, the Obstetrics and Maternity module was approved by the National Health and Medical Research Council (NHMRC) in December 2014, and released on 23 March 2015.
The module contains a series of recommendations based on evidence from the systematic review; practice points developed through consensus decision making by the Clinical/Consumer Reference Group (CRG) where there was insufficient high quality data; and thirdly, unique so far to the fifth module, expert opinion points to guide practice in areas outside the scope of the systematic review.
Evidence from the systematic review led to four recommendations. Firstly, routine administration of iron supplementation to all pregnant women is not recommended. The administration of iron to pregnant women with iron deficiency is recommended, but not the routine addition of folic acid. Finally, ESAs should not be routinely used in maternity patients. Further guidance regarding anaemia and iron therapy is provided in the form of practice points.
The module also covers blood group and screen during pregnancy; planning for when transfusion is not an option; transfusion in women who are not actively bleeding, and when there is critical bleeding including the use of massive transfusion protocol. The use of modified blood components (CMV negative and phenotyped); transfusion support for maternity care/services; guidance for coagulopathic patients at risk of bleeding; and the use of recombinant activated factor VIIa, cell salvage, interventional radiology also feature.
To learn more about obstetric and maternal patient blood management and the PBM guidelines, why not register to attend Transfusion Update: Obstetric and Maternal Patient Blood Management either in person or by webinar. This session will cover PBM in maternity care including iron deficiency anaemia, indications for blood product support during pregnancy, the needs of the growing fetus and critical bleeding.
Wednesday 13 May, 1.30pm – 3.00pm (Sydney time), at The Royal Women’s Hospital, 20 Flemington Rd, Parkville, or by webinar.
Presented by Dr Helen Savoia, Head of Haematology, The Royal Children’s Hospital, Dr Wendy Pollock, Critical Care Nurse and Midwife, Mercy Hospital for Women, and Dr Shelley Rowlands, Obstetrician and Fetal Maternal Specialist, Royal Women’s Hospital. The session is Chaired by Mr Leigh McJames, General Manager, National Blood Authority.
Dr Sandy Minck, the author of this post, is a Medical Officer at the Australian Red Cross Blood Service and a member of the Transfusion Practice and Education team.