Retrospective study on the timing of termination of erythrocyte infusion in patients with severe postpartum hemorrhage

Abstract

Objective To evaluate the appropriate time and reasonable indicator of ending the erythrocyte transfusion in patients with severe postpartum hemorrhage. Methods A retrospective study was performed, where the hemoglobin (Hb) and hematocrit (Hct) values were taken as test variables and the infusion of erythrocytes was stopped, and the Hb>70 g/L of 24 h after the infusion of erythrocytes was taken as the state variable, and the receiver operating characteristic (ROC) curve was drawn to calculate area under receiver operating characteristic curve(AUC) and cut-off value. Based on the AUC area in the ROC curve, the study was conducted. Patients with severe postpartum hemorrhage whose test variables were less than or equal to cut-off value were divided into group A(n=34), and the rest were divided into group B(n=53). Bleeding volume, blood transfusion volume, hemoglobin content after red blood cell infusion were stopped, and heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were compared 24 h after red blood cell infusion was stopped. The damage of new organs, length of stay and total cost of hospitalization were compared in the two groups. Results The AUC area of Hb was calculated as 0.825 [95%confidence interval (CI) 0.725-0.925] when the infusion was stopped, and the cut-off value of Hb when the infusion was stopped was 86.5 g/L (sensitivity 72.5%, specificity 87.5%). The AUC area of Hct was 0.780 (95%CI 0.665-0.895) when the infusion was stopped, and the cut-off value of Hct when the infusion was stopped was 27.65% (sensitivity 65.2% and specificity 71.2%). There was no significant difference in bleeding volume between the two groups (P>0.05). The mean Hb values of the patients in the two groups were (79±6) g/L in group A and (100±10) g/L in group B, respectively, after the transfusion of erythrocytes was stopped. The difference between the two groups was statistically significant (P 0.05). The incidence of oxygenation index 0.05). Conclusions Hb is better than Hct in evaluating the indicators of stopping transfusion of red blood cells in patients with severe postpartum hemorrhage. When the body Hb reached 86.5 g/L, it was possible the appropriate time for ending erythrocyte transfusion, with beneficial effects on the body. It was also found that the occurrence of organ injury rises with the increase of erythrocyte transfusion. Key words: Postpartum hemorrhage; Erythrocyte infusion; Terminating time; Receiver operating characteristic curve