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Kasraeian M, Asadian F, Naderi N, Bazrafshan K, kasraian L. Frequency and Determinants of Blood Transfusion Among Pregnant Women at Hafez Hospital, Shiraz. bloodj 2025; 22 (3) :219-226
URL: http://bloodjournal.ir/article-1-1577-en.html
Frequency and Determinants of Blood Transfusion Among Pregnant Women at Hafez Hospital, Shiraz
Maryam Kasraeian , Fatemeh Asadian , Nima Naderi , Khadijeh Bazrafshan , Leila Kasraian *
Keywords: Blood Transfusion, Anaemia, Pregnancy, Pregnancy complications
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      References:
  1. World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. USA: World Health Organization; 2023. p. 35-29.
  2. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2(6): e323-33. [DOI:10.1016/S2214-109X(14)70227-X] [PMID]
  3. Liu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21(1): 332. [DOI:10.1186/s12884-021-03818-1] [PMID] []
  4. Ueda A, Nakakita B, Chigusa Y, Mogami H, Ohtera S, Kato G, et al. Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study. BMC Pregnancy Childbirth. 2022; 22(1): 496. [DOI:10.1186/s12884-022-04824-7] [PMID] []
  5. Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global prevalence of anemia in pregnant women: a comprehensive systematic review and meta-analysis. Matern Child Health J 2022; 26(7): 1473-87. [DOI:10.1007/s10995-022-03450-1] [PMID]
  6. James AH. Iron deficiency anemia in pregnancy. Obstet Gynecol 2021; 138(4): 663-74. [DOI:10.1097/AOG.0000000000004559] [PMID]
  7. Benson AE, Shatzel JJ, Ryan KS, Hedges MA, Martens K, Aslan JE, et al. The incidence, complications, and treatment of iron deficiency in pregnancy. Eur J Haematol 2022; 109(6): 633-42. [DOI:10.1111/ejh.13870] [PMID] []
  8. Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open 2022; 5(2): e2147046. [DOI:10.1001/jamanetworkopen.2021.47046] [PMID] []
  9. Patterson JA, Roberts CL, Bowen JR, Irving DO, Isbister JP, Morris JM, et al. Blood transfusion during pregnancy, birth, and the postnatal period. Obstet Gynecol 2014; 123(1): 126-33. [DOI:10.1097/AOG.0000000000000054] [PMID]
  10. Holm C, Langhoff‐Roos J, Petersen K, Norgaard A, Diness BR. Severe postpartum haemorrhage    and    mode     of      delivery:   a retrospective cohort study. BJOG 2012; 119(5): 596-604. [DOI:10.1111/j.1471-0528.2011.03267.x] [PMID]
  11. Jakobsson M, Gissler M, TAPPER AM. Risk factors for blood transfusion at delivery in Finland. Acta Obstet Gynecol Scand 2013; 92(4): 414-20. [DOI:10.1111/j.1600-0412.2012.01490.x] [PMID]
  12. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012; 120(5): 1029-36. [DOI:10.1097/AOG.0b013e31826d60c5] [PMID] []
  13. Lutomski JE, Greene RA, Byrne BM. Severe maternal morbidity during childbirth hospitalisation: a comparative analysis between the Republic of Ireland and Australia. Eur J Obstet Gynecol Reprod Biol 2012; 163(2): 148-53.[DOI:10.1016/j.ejogrb.2012.05.003] [PMID]
  14. Kuklina EV, Whiteman MK, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12(4): 469-77. [DOI:10.1007/s10995-007-0256-6] [PMID]
  15. Joseph K, Rouleau J, Kramer M, Young D, Liston R, Baskett T, et al. Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007; 114(6): 751-9. [DOI:10.1111/j.1471-0528.2007.01316.x] [PMID]
  16. Sosa CG, Althabe F, Belizán JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol 2009; 113(6): 1313-9. [DOI:10.1097/AOG.0b013e3181a66b05] [PMID] []
  17. Obeagu EI, Ubosi NI, Uzoma G. Maternal Hemorrhage and Blood Transfusions: Safeguarding Pregnancy Health. Int J Curr Res Chem Pharm Sci 2023; 10(11): 26-35. [DOI:10.22270/ijmspr.v10i3.112]
  18. Iqbal K, Iqbal A, Rathore SS, Ahmed J, Ali SA, Farid E, et al. Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis. Transfus Clin Biol 2022; 29(1): 3-10. [DOI:10.1016/j.tracli.2021.09.010] [PMID]
  19. Kloka JA, Friedrichson B, Jasny T, Old O, Piekarski F, Zacharowski K, et al. Anemia, red blood cell transfusion and administration of blood products in obstetrics: a nationwide analysis  of  more  than  6  million   cases   from 2011-2020. Blood Transfus 2023; 22(1): 37-45.
  20. Liao Z, Zhao X, Rao H, Kang Y. Analysis of correlative risk factors for blood transfusion therapy for extremely low birth weight infants and extreme preterm infants. Am J Transl Res 2021; 13(7): 8179-85.
  21. Hussain M, Azeem MI, Yusaf A. Evaluation of Blood Reservation and Use for Caesaren Sections in a tertiary maternity hospital in Pakistan. PJMHS 2015; 9(1): 5-9.
  22. Breymann C. Iron Deficiency Anemia in Pregnancy. Semin Hematol 2015; 52(4): 339-47. [DOI:10.1053/j.seminhematol.2015.07.003] [PMID]
  23. Ende HB, Lozada MJ, Chestnut DH, Osmundson SS, Walden RL, Shotwell MS, et al. Risk factors for atonic postpartum hemorrhage: a systematic review and meta-analysis. Obstet Gynecol 2021; 137(2): 305-23. [DOI:10.1097/AOG.0000000000004228] [PMID] []
  24. Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med 2021; 384(17): 1635-45. [DOI:10.1056/NEJMra1513247] [PMID] []
  25. Hu H, Wang L, Gao J, Chen Z, Chen X, Tang P, et al. Risk factors of severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24(1): 674. [DOI:10.1186/s12884-024-06876-3] [PMID] []
  26. Faysal H, Araji T, Ahmadzia HK. Recognizing who is at risk for postpartum hemorrhage: targeting anemic women and scoring systems for clinical use. Am J Obstet Gynecol MFM 2023; 5(2S): 100745. [DOI:10.1016/j.ajogmf.2022.100745] [PMID]



Frequency and Determinants of Blood Transfusion Among Pregnant Women at Hafez Hospital, Shiraz
 ‎
Maryam Kasraian1      , Fatemeh Asadian2       , Nima Naderi3      , Khadijeh Bazrafshan4       , Leila Kasraian5,6


1Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
3Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4Shiraz University of Medical Sciences, Shiraz, Iran
5Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
6Shiraz Blood Transfusion Center, Shiraz, Iran

Received: 2025/03/09
Accepted: 2025/08/18
 





http://dx.doi.org/10.61186/bloodj.22.1.54
    



Citation:
Kasraian M, Asadian F, Naderi N, Bazrafshan Kh, Kasraian L. Frequency and Determinants of Blood Transfusion Among Pregnant Women at Hafez Hospital, Shiraz. J Iran Blood Transfus. 2025: 22 (3): 219-226
    



Correspondence: Kasraian L., Associate Professor of Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine and Shiraz Blood Transfusion Center.
P.O.Box: 1153, Shiraz, Iran.
Tel: (+9871) 6273445
E-mail:
1- Acridine Orange
1- Biological safety cabinet
1- Platelet Concentrate
2- Food and Drug Administration
3- Normal Skin Flora
4- Platelet Rich Plasma-Platelet Concentrate
5- Eosin-Methylene blue
6- Thioglycolate
1- Acridine Orange
1- Biological safety cabinet
1- Platelet Concentrate
2- Food and Drug Administration
3- Normal Skin Flora
4- Platelet Rich Plasma-Platelet Concentrate
5- Eosin-Methylene blue
6- Thioglycolate
l.kasraian@tmi.ac.ir  		 A B S T R A C T
Background and Objectives
Blood and blood product transfusion is a critical interventions for managing severe bleeding related to pregnancy and childbirth and plays a key role in reduction of maternal mortality. Given the high prevalence of anemia in pregnancy, multiple bleeding risk factors, and the necessity of optimizing the use of limited blood resources, this study investigated the frequency, usage patterns, and determinants of blood and blood product transfusion in pregnant women admitted to Hafez Hospital, in Shiraz.
Materials and Methods
This retrospective case-control study, reviewed the medical records of 1119 pregnant women hospitalized from 2017 to 2021. The case group comprised 527 women who received blood or blood products, while the control group included 592 women with no history of transfusion. Collected data included demographic characteristics, clinical and laboratory findings, pregnancy complications, and blood bank recods. Data were analyzed using independent t-test and Chi-square statistical tests with SPSS version 28.
Results
The most common indications for blood transfusion were low hemoglobin (54.46%), active bleeding (18.4%), and placental disorders (9.68%). Factors associated with transfusion included history of cesarean section ,, underlying diseases Particularly thalassemia minor , multiple pregnancy, high systolic blood pressure at admission, low hemoglobin, preeclampsia , fetal distress, premature rupture of membranes, and intrauterine growth restriction. The average number of transfused units was 2.15 for red blood cells (CI: 95% 1.97-2.33), 3.78 for plasma (CI: 95% 3.28-4.28), and 3.69 for platelets (CI: 95% 3.37-4.01). Among recipients, 98% received red blood cells, 10.17% platelets, 10.17% plasma, and 2.5% cryoprecipitate.
Conclusions 
Anemia and bleeding were identified as the primary causes of blood transfusion during pregnancy.  Enhancing systematic screening and timely treatment of anemia, strengthening prenatal care, reducing unnecessary cesarean sections, and developing standard protocols for obstetric complications may significantly reduce the need for blood and blood product transfusions.
Key words: Blood Transfusion, Anaemia, Pregnancy; Pregnancy complications
 
Copyright © 2025 Journal of Iranian Blood Transfusion, Published by Blood Transfusion Research Center.
This work is licensed under a Creative Common Attribution-Non Commercial 4.0 International license.




 

 
Type of Study: Research | Subject: Blood transfusion medicine
References
1. World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. USA: World Health Organization; 2023. p. 35-29.
2. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2(6): e323-33. [DOI:10.1016/S2214-109X(14)70227-X] [PMID]
3. Liu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21(1): 332. [DOI:10.1186/s12884-021-03818-1] [PMID] []
4. Ueda A, Nakakita B, Chigusa Y, Mogami H, Ohtera S, Kato G, et al. Impact of efforts to prevent maternal deaths due to obstetric hemorrhage on trends in epidemiology and management of severe postpartum hemorrhage in Japan: a nationwide retrospective study. BMC Pregnancy Childbirth. 2022; 22(1): 496. [DOI:10.1186/s12884-022-04824-7] [PMID] []
5. Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global prevalence of anemia in pregnant women: a comprehensive systematic review and meta-analysis. Matern Child Health J 2022; 26(7): 1473-87. [DOI:10.1007/s10995-022-03450-1] [PMID]
6. James AH. Iron deficiency anemia in pregnancy. Obstet Gynecol 2021; 138(4): 663-74. [DOI:10.1097/AOG.0000000000004559] [PMID]
7. Benson AE, Shatzel JJ, Ryan KS, Hedges MA, Martens K, Aslan JE, et al. The incidence, complications, and treatment of iron deficiency in pregnancy. Eur J Haematol 2022; 109(6): 633-42. [DOI:10.1111/ejh.13870] [PMID] []
8. Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open 2022; 5(2): e2147046. [DOI:10.1001/jamanetworkopen.2021.47046] [PMID] []
9. Patterson JA, Roberts CL, Bowen JR, Irving DO, Isbister JP, Morris JM, et al. Blood transfusion during pregnancy, birth, and the postnatal period. Obstet Gynecol 2014; 123(1): 126-33. [DOI:10.1097/AOG.0000000000000054] [PMID]
10. Holm C, Langhoff‐Roos J, Petersen K, Norgaard A, Diness BR. Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. BJOG 2012; 119(5): 596-604. [DOI:10.1111/j.1471-0528.2011.03267.x] [PMID]
11. Jakobsson M, Gissler M, TAPPER AM. Risk factors for blood transfusion at delivery in Finland. Acta Obstet Gynecol Scand 2013; 92(4): 414-20. [DOI:10.1111/j.1600-0412.2012.01490.x] [PMID]
12. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012; 120(5): 1029-36. [DOI:10.1097/AOG.0b013e31826d60c5] [PMID] []
13. Lutomski JE, Greene RA, Byrne BM. Severe maternal morbidity during childbirth hospitalisation: a comparative analysis between the Republic of Ireland and Australia. Eur J Obstet Gynecol Reprod Biol 2012; 163(2): 148-53. [DOI:10.1016/j.ejogrb.2012.05.003] [PMID]
14. Kuklina EV, Whiteman MK, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12(4): 469-77. [DOI:10.1007/s10995-007-0256-6] [PMID]
15. Joseph K, Rouleau J, Kramer M, Young D, Liston R, Baskett T, et al. Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007; 114(6): 751-9. [DOI:10.1111/j.1471-0528.2007.01316.x] [PMID]
16. Sosa CG, Althabe F, Belizán JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol 2009; 113(6): 1313-9. [DOI:10.1097/AOG.0b013e3181a66b05] [PMID] []
17. Obeagu EI, Ubosi NI, Uzoma G. Maternal Hemorrhage and Blood Transfusions: Safeguarding Pregnancy Health. Int J Curr Res Chem Pharm Sci 2023; 10(11): 26-35. [DOI:10.22270/ijmspr.v10i3.112]
18. Iqbal K, Iqbal A, Rathore SS, Ahmed J, Ali SA, Farid E, et al. Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis. Transfus Clin Biol 2022; 29(1): 3-10. [DOI:10.1016/j.tracli.2021.09.010] [PMID]
19. Kloka JA, Friedrichson B, Jasny T, Old O, Piekarski F, Zacharowski K, et al. Anemia, red blood cell transfusion and administration of blood products in obstetrics: a nationwide analysis of more than 6 million cases from 2011-2020. Blood Transfus 2023; 22(1): 37-45.
20. Liao Z, Zhao X, Rao H, Kang Y. Analysis of correlative risk factors for blood transfusion therapy for extremely low birth weight infants and extreme preterm infants. Am J Transl Res 2021; 13(7): 8179-85.
21. Hussain M, Azeem MI, Yusaf A. Evaluation of Blood Reservation and Use for Caesaren Sections in a tertiary maternity hospital in Pakistan. PJMHS 2015; 9(1): 5-9.
22. Breymann C. Iron Deficiency Anemia in Pregnancy. Semin Hematol 2015; 52(4): 339-47. [DOI:10.1053/j.seminhematol.2015.07.003] [PMID]
23. Ende HB, Lozada MJ, Chestnut DH, Osmundson SS, Walden RL, Shotwell MS, et al. Risk factors for atonic postpartum hemorrhage: a systematic review and meta-analysis. Obstet Gynecol 2021; 137(2): 305-23. [DOI:10.1097/AOG.0000000000004228] [PMID] []
24. Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med 2021; 384(17): 1635-45. [DOI:10.1056/NEJMra1513247] [PMID] []
25. Hu H, Wang L, Gao J, Chen Z, Chen X, Tang P, et al. Risk factors of severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24(1): 674. [DOI:10.1186/s12884-024-06876-3] [PMID] []
26. Faysal H, Araji T, Ahmadzia HK. Recognizing who is at risk for postpartum hemorrhage: targeting anemic women and scoring systems for clinical use. Am J Obstet Gynecol MFM 2023; 5(2S): 100745. [DOI:10.1016/j.ajogmf.2022.100745] [PMID]
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