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Chapter 34 - Transfusion and Anaphylactic and Adverse Drug Reactions in Pregnancy

from Section 6 - Anaesthetic Emergencies During Pregnancy

Published online by Cambridge University Press:  06 May 2021

Edwin Chandraharan
St George's University of London
Sir Sabaratnam Arulkumaran
St George's University of London
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Incidence Obstetric blood transfusion represents a small proportion of overall blood use. However, the use of blood products in obstetrics is rising as postpartum haemorrhage rates continue to increase.

There is evidence of increasing rates of maternal red blood cell transfusion during childbirth worldwide, mainly in the context of postpartum haemorrhage [1–4]. In the United States, there was a steep increase in peripartum transfusion (from 0.3% to 1.0%) between 1998 and 2009 [5].

Outside the context of major haemorrhage, there is little evidence for the benefit of blood transfusion in fit, healthy, asymptomatic patients. The decision to transfuse must be based on careful clinical assessment in conjunction with the haemoglobin level [6].

Obstetric and Intrapartum Emergencies
A Practical Guide to Management
, pp. 245 - 251
Publisher: Cambridge University Press
Print publication year: 2021

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Callaghan, WM, Kuklina, EV, Berg, CJ. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol. 2010;202(4):353.e1–6.CrossRefGoogle ScholarPubMed
Jakobsson, M, Gissler, M, Tapper, A-M. Risk factors for blood transfusion at delivery in Finland. Acta Obstet Gynecol Scand. 2012;92(4):414–20.Google ScholarPubMed
Joseph, K, Rouleau, J, Kramer, M, Young, D, Liston, R, Baskett, T. Investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007;114(6):751–9.CrossRefGoogle ScholarPubMed
Lutomski, J, Byrne, B, Devane, D, Greene, R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119(9):1150–1.Google ScholarPubMed
Patterson, J, Roberts, C, Bowen, J, Irving, D, Isbister, J, Morris, J, et al. Blood transfusion During pregnancy, birth, and the postnatal period. Obstet Anesth Dig. 2014;34(4):203–4.Google Scholar
Royal College of Obstetricians and Gynaecologists. Blood transfusion in Obstetrics. Green-top Guideline 47.2015. London: RCOG. Scholar
Ehrenthal, DB, Chichester, ML, Cole, OS, Jiang, X. Maternal risk factors for peripartum transfusion. J Womens Health. 2012;21(7):792–7.Google ScholarPubMed
SHOT Annual Reports and Summaries [Internet]. Serious Hazards of Transfusion. Available from: Scholar
Ibrahim, UN. Acute blood transfusion reactions in pregnancy, an observational study from north eastern Nigeria. J Blood Disord Transfus. 2013;04(03).Google Scholar
Vamvakas, EC, Blajchman, MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009;113(15):3406–17.CrossRefGoogle ScholarPubMed
Gaines, AR, Lee-Stroka, H, Byrne, K, Scott, DE, Uhl, L, Lazarus, E, et al. Investigation of whether the acute hemolysis associated with Rho(D) immune globulin intravenous (human) administration for treatment of immune thrombocytopenic purpura is consistent with the acute hemolytic transfusion reaction model. Transfusion. 2009;49(6):1050–8.CrossRefGoogle ScholarPubMed
Popovsky, MA. Transfusion-associated circulatory overload: the plot thickens. Transfusion. 2009;49(1):24.Google ScholarPubMed
Transfusion-related acute lung injury (TRALI). https://professionaleducation.blood.caGoogle Scholar
Maxwell, MJ, Wilson, MJA. Complications of blood transfusion. Cont Educ Anaesth Crit Care Pain. 2006;6(6):225–9.Google Scholar
Hewitt, PE, Machin, SJ. ABC of transfusion: Massive blood transfusion. BMJ. 1990;300(6717):107–9.Google ScholarPubMed
Donaldson, M, Seaman, M, Park, G. Massive blood transfusion. Br J Anaesth. 1992;69(6):621–30.CrossRefGoogle ScholarPubMed
Rezaei, N, Amini-Kafiabad, S, Maghsudlu, M, Abolghasemi, H. Risk factor analysis of hepatitis C virus seropositivity in Iranian blood donors: a case-control study. Transfusion. 2016;56(7):1891–8.CrossRefGoogle ScholarPubMed
Johansson, S. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832–6.CrossRefGoogle ScholarPubMed
Hepner, DL, Castells, M, Mouton-Faivre, C, Dewachter, P. Anaphylaxis in the clinical setting of obstetric anesthesia. Anesth Analg. 2013;117(6):1357–67.Google ScholarPubMed
Khan, BQ, Kemp, SF. Pathophysiology of anaphylaxis. Curr Opin Allergy Clin Immunol. 2011;11(4):319–25.Google ScholarPubMed
Shahzad Mustafa, S, Kaliner, MA. Anaphylaxis. 2018. Scholar
Ring, J, Messmer, K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;309(8009):466–9.CrossRefGoogle Scholar
National Audit Project 6. Perioperative anaphylaxis. Scholar
Mccall, S, Bunch, K, Brocklehurst, P, D’arcy, R, Hinshaw, K, Kurinczuk, J, et al. The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population-based descriptive study. BJOG. 2018;125(8):965–71.Google ScholarPubMed
Mulla, ZD, Ebrahim, MS, Gonzalez, JL. Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database. Ann Allergy Asthma Immunol. 2010;104(1):55–9.Google ScholarPubMed
Marr, L, Lennox, C, Mcfadyen, AK. Quantifying severe maternal morbidity in Scotland. Curr Opin Anaesthesiol. 2014;27(3):275–81.CrossRefGoogle ScholarPubMed
Simons, FER, Ardusso, LRF, Bilò, MB, El-Gamal, YM, Ledford, DK, Ring, J, et al. World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis. World Allergy Org J. 2011;4(2):1336.CrossRefGoogle ScholarPubMed
Khan, R, Anastasakis, E, Kadir, RA. Anaphylactic reaction to ceftriaxone in labour: An emerging complication. J Obstet Gynaecol. 2008;28(7):751–3.CrossRefGoogle Scholar
Sengupta, A, Kohli, JK. Antibiotic prophylaxis in cesarean section causing anaphylaxis and intrauterine fetal death. J Obstet Gynaecol Res. 2008;34(2):252–4.CrossRefGoogle ScholarPubMed
Shingai, Y, Nakagawa, K, Kato, T, Fujioka, T, Matsumoto, T, Kihana, T, et al. Severe allergy in a pregnant woman after vaginal examination with a latex glove. Gynecol Obstet Invest. 2002;54(3):183–4.Google Scholar
Rosen, FS. Urticaria, angioedema, and anaphylaxis. Pediatr Rev. 1992;13(10):387–90.Google ScholarPubMed
Kramer, MS, Rouleau, J, Baskett, TF, Joseph, K. Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet. 2006;368(9545):1444–8.CrossRefGoogle ScholarPubMed
Simons, FER, Schatz, M. Anaphylaxis during pregnancy. J Allergy Clin Immunol. 2012;130(3):597606.CrossRefGoogle ScholarPubMed
Hakkarainen, KM, Hedna, K, Petzold, M, Hägg, S. Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions: a meta-analysis. PLoS ONE. 2012;7(3).CrossRefGoogle ScholarPubMed
Sultana, J, Cutroneo, P, Trifirò, G. Clinical and economic burden of adverse drug reactions. J Pharmacol Pharmacotherapeut. 2013;4(5):73.CrossRefGoogle ScholarPubMed
Wettach, C, Thomann, J, Lambrigger-Steiner, C, Buclin, T, Desmeules, J, Mandach, UV. Pharmacovigilance in pregnancy: adverse drug reactions associated with fetal disorders. J Perinat Med. 2013;41(3).CrossRefGoogle ScholarPubMed
Oliveira-Filho, ADD, Vieira, AES, Silva, RCD, Neves, SJF, Gama, TAB, Lima, RV, et al. Adverse drug reactions in high-risk pregnant women: a prospective study. Saudi Pharmaceut J. 2017;25(7):1073–7.Google ScholarPubMed
Miguel, A, Azevedo, LF, Araújo, M, Pereira, AC. 2012. Frequency of adverse drug reactions in hospitalized patients: a systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 21(11):1139–54.CrossRefGoogle ScholarPubMed
Cano, F G, Rozenfeld Cad, S. Adverse drug events in hospitals: a systematic review. Saúde Pública (Rio de Janeiro). 2009;25(Suppl 3):S360S372.CrossRefGoogle ScholarPubMed
Lacroix, I, Cabou, C, Montastruc, J-L, Damase-Michel, C. Adverse drug reactions in pregnant women. Therapie. 2007;62(5):455–60.Google ScholarPubMed
Wacker, E, Navarro, A, Meister, R, Padberg, S, Weber-Schoendorfer, C, Schaefer, C. Does the average drug exposure in pregnant women affect pregnancy outcome? A comparison of two approaches to estimate the baseline risks of adverse pregnancy outcome. Pharmacoepidemiol Drug Safety. 2015;24(4):353–60.CrossRefGoogle ScholarPubMed

Further Reading

Cook, T, Harper, N, Farmer, L, Garcez, T, Floss, K, Marinho, S, et al. Anaesthesia, surgery, and life-threatening allergic reactions: protocol and methods of the 6th National Audit Project (NAP6) of the Royal College of Anaesthetists. Br J Anaesth. 2018;121(1):124–33.Google Scholar
Kroigaard, M, Garvey, LH, Gillberg, L, Johansson, SGO, Mosbech, H, Florvaag, E, et al. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand. 2007;51(6):655–70.CrossRefGoogle ScholarPubMed

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