Transfusion triggers in patients with postpartum haemorrhage

Postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality both in developed and developing countries. In the Netherlands, we reported an incidence of severe PPH (defined as ≥1000 ml blood loss) of 4·5% in the period 2000–2008. As the majority of women who experience PPH have no identifiable clinical or historical risk factors, all women must be considered at risk and active third-stage management is recommended in all women to prevent PPH. Red blood cell (RBC) transfusion is often necessary in the treatment of women who suffered from PPH. However, the current awareness of transfusion-related complications (blood-borne infections, transfusion reactions and immunologic effects) and the cost prompted a re-evaluation of the transfusion practice. With only small differences in physical fatigue scores and no differences in secondary outcomes, we recommend implementation of a restrictive transfusion policy for women with PPH without severe anaemic complaints. This restrictive transfusion policy saves €438 per woman compared to a liberal transfusion policy. In addition, we recommend implementation of health-related quality of life scores for counselling and decision-making in clinical practice regarding transfusion policy after PPH.