Date Published: May 28, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Sudha Salhan, Vrijesh Tripathi, Rajvir Singh, Harsha S. Gaikwad.
Objectives. Anemia is a major public health problem throughout the world which assumes prominence in pregnant mothers. Patients with severe anemia continue to present themselves at term or in labor. This study was conducted to compare the improvements in hematological parameters of patients receiving partial exchange blood transfusion and transfusion of packed cells without exchange. Methods. One hundred and twenty-five severely anemic antenatal mothers were admitted from outpatient service. Partial exchange transfusion was given to sixty-six patients while fifty-nine received transfusion of packed cells with frusemide cover. Results. The two groups were comparable in terms of age, height, weight, religion, diet, education, occupation of self and husband, and income. Hemoglobin level in Group 1 was comparatively less than Group 2 at prelevel (5.2 ± 1.5 versus 6.6 ± 2.3, P = 0.001) and postlevel (7.2 ± 1.5 versus 8.6 ± 1.8, P = 0.001), respectively, but there was no significant difference between the two modes of transfusion (2.09 ± 1.6 versus 2.01 ± 1.5, P = 0.78). Conclusion. The study produced an equally significant improvement in hematological parameters in partial exchange and packed cell transfusion. Platelet counts were significantly less in partial exchange as compared with packed cell transfusion.
Anemia has an estimated global prevalence of 42% among pregnant women. It is estimated that anemia causes more than 115000 maternal and 591000 perinatal deaths globally per year . The baseline measure of hemoglobin concentration that categorizes anemia is less than 7.0 g/dL for severe anemia, 7.0–9.9 g/dL for moderate anemia, and 10.0–11.9 g/dL for mild anemia . The estimated prevalence of anemia among pregnant women in India is higher than the global prevalence at 49.7% . According to survey data, 84.9% of pregnant women are anemic with 60.1% having moderate anemia and 13.1% having severe anemia . A study recorded that the prevalence of anemia in pregnant women and children among slum dwellers in Delhi was as high as 80.6% and 93.3%, respectively . Anemia has been identified as a public health problem yet the problem is accentuated when pregnant women present themselves with severe anemia late in labor.
This was a comparative retrospective study conducted in the Department of Obstetrics and Gynaecology of Safdarjung Hospital, New Delhi, India, during the period June 2009 and January 2011. One hundred and twenty-five severely anemic antenatal mothers were recruited from the outpatient service and Emergency Department. Sixty-six patients with severe anemia who presented themselves in one of the units of the Department were administered partial exchange. In the other units there were fifty-nine patients with severe anemia which were given transfusion of packed cells with frusemide cover during the same time period. All parameters were recorded from patient record files while the patient was admitted in the hospital wards.
Descriptive statistics in the form of means and standard deviations for interval variables and frequency and percentages for categorical variables were calculated. To see statistical significance within variables for before and after, parametric and nonparametric tests such as Paired t-test and Wilcoxon Sign Rank test, were used for interval variables and McNemar’s tests for categorical variables. Mann Whitney U test and Independent Student t-test were used for pre- and post-differences as well as between the groups for interval variables wherever applicable. P value of less than 0.05 (two tailed) has been considered for statistical significance level. SPSS 12.0 Statistical Package was used for the analysis.
The study included one hundred and twenty-five antenatal mothers. Out of them sixty-six were given partial exchange blood transfusion (Group 1) whereas fifty-nine were given packed cell transfusion with frusemide cover (Group 2). Demographic details were recorded and are presented in Table 1. The average age of patients was 25 years and most patients were Hindu (94%) and nonsmokers (98%). 12% of husbands and 33% of patients were illiterate. 63% husbands were unskilled and 92% were nonworking housewives. There were no differences in subject’s education, occupation, diet, and birth interval between the groups. Almost 50% of the total women were vegetarians. Women with parity of less than 2 were more in Group 2 than in Group 1, indicating that there were more women with higher parity in Group 1. The difference was statistically significant.
There were sixty-six women with anemia in Group 1 and fifty-nine women in Group 2. The two groups were comparable in terms of age, height, weight, religion, diet, education, income, and occupation of self and husband. However, there were more nulliparous women in Group 2 than in Group 1. There were more women with parity more than 3, in Group 1 than in Group 2. The difference was statistically significant. A review of studies done in Malawi records that three studies found prevalence of severe anemia to be higher in primipara than in multipara adolescents, but the differences were not statistically significant . Our study results did not corroborate with this.
Being a retrospective study, complete records were not found in medical records for some variables, and hence the analysis was restricted for the available data only. A randomized clinical trial is warranted for more efficient results.
Despite improvement in peripheral health services and all preventive measures, patients of severe anemia at term or in labor are still received. Oral and parenteral irons are slow to act and do not build up hemoglobin to the required levels in a short time before the patients go into labor. The problem is compounded by the fact that iron supplementation during pregnancy is effective in eliminating iron deficiency anemia under controlled and supervised conditions, yet under field conditions, its effectiveness in most countries has been unimpressive . This study was done to validate partial exchange blood transfusion as a method of blood transfusion in antenatal mothers with severe anemia keeping in mind the technical and blood bank limitations that can arise in a small setup. Partial exchange is a procedure that can be done not just at the tertiary level but at primary health level also. The improvements observed in the selected parameters with blood transfusion (with or without exchange) do not suggest that it improves the obstetric outcome too. Research is also needed to clarify the relationship between level of prior anemia, on the one hand, and maternal survival and pregnancy outcome, on the other, to determine the extent to which prophylaxis and treatment modify risk of morbidity and mortality.