Introduction: Anaemia is extremely common in pregnancy and has serious implications on maternal and fetal health. In cases of severe anaemia where haemoglobin is less than 70g/L, red blood cell transfusion may be required, however there is no universally accepted standard for transfusion in pregnancy. Therefore the decision to transfuse is currently made after consideration of clinical and haematological markers. The aim of this report is to review the literature regarding antenatal blood transfusion for severe antenatal anaemia.
Methods: Current literature related to the outcomes and management of severe antenatal anaemia was reviewed in the context of a 35-year-old woman who was referred to our district hospital at 36+4 weeks gestation with a haemoglobin of 47g/L, on a background of polysubstance abuse and minimal prior antenatal care.
Results: 56.4 million pregnant women (41.8%) worldwide suffer from anaemia. Fetal impacts can be significant, including impaired psychomotor or mental development, low birth weight, premature birth and increased neonatal morbidity. Maternal consequences include fatigue, dyspnoea, decreased immune function and greater morbidity following post partum haemorrhage. When managing severe antenatal anaemia, the current National Blood Authority Patient Blood Management Guidelines suggest the consideration of transfusion if haemoglobin is below 70g/L or the patient is symptomatic. Upon review of the literature, there were no studies that examined the maternal or perinatal outcomes of blood transfusion for the treatment of antenatal anaemia.
Discussion: Without concrete evidence to guide current practice for the management of severe antenatal anaemia, clinicians must use their best judgment in deciding the suitability of blood transfusion, whilst weighing the risks and benefits to the mother and fetus. We recommend the consideration of antenatal blood transfusion if haemoglobin is less than 70g/L (particularly if less than 60 g/L) and there is ongoing haemorrhage, hypovolemia, severe symptoms or evidence of cardiac decompensation.