Study finds link Between RBC transfusion and anemia in placenta accreta spectrum

Red blood cell (RBC) transfusion is linked to renal failure presence in women with placenta accreta spectrum (PAS), according to a recent study published in Scientific Reports.¹

Takeaways

Placenta accreta spectrum (PAS) presents significant risks during childbirth, with abnormal placenta increasing the likelihood of major hemorrhage, impacting maternal morbidity and mortality.
Anemia is a prevalent concern during pregnancy, affecting 42% of pregnant women and potentially leading to adverse perinatal outcomes and increased transfusion needs, particularly in PAS cases.
RBC transfusion rates are notably higher among women with PAS, with a median of 5.19 transfusions per patient, emphasizing the severity of hemorrhagic complications in this population.
PAS patients are significantly more likely to experience anemia, postpartum hemorrhage, and other complications compared to those without PAS, indicating the necessity for specialized care and interventions.
The study underscores the importance of detecting and managing prepartum anemia in women diagnosed with PAS to mitigate the risk of peripartum complications, highlighting the need for proactive management strategies in this high-risk population.

PAS includes placenta increta, placenta accrete, and placenta percreta, and has been reported in an estimated 0.18% of US births. Major hemorrhage risk is significantly increased by abnormal placenta, heightening the odds of maternal morbidity and mortality.

One study reported a median 3000 ml blood loss during delivery among women with PAS. Another study reported a mean 5.19 RBC transfusions per patient, with higher rates among women with unscheduled, emergent deliveries.

Anemia is an additional complication during pregnancy, impacting 42% of pregnant women. This may lead to worse perinatal outcomes, fatigue, postpartum depression, and increased transfusion requirements. The risk of baseline anemia is increased in patients with PAS and antepartum bleeding.

According to the Centers for Disease Control and Prevention, approximately 800,000 visits to the emergency department with anemia as the primary diagnosis group occur per year.² The reported death rate for anemia is 1.8 per 100,000 population, indicating the severity of this condition.

Investigators conducted a study to evaluate anemia, RBC transfusion, and outcomes in women with a PAS diagnosis in the previous 10 years.¹ Women hospitalized for delivery in Germany from January 1, 2012, to December 31, 2021, were included in the analysis.

Exclusion criteria included the code for the pathological condition of the placenta, unspecified. Diagnoses were reported based on International Statistical Classification of Diseases and Related Health Problems and International Statistical Classification of Procedures codes.

All data and age groups from 2012 to 2021 were included in the analysis. However, accounting aspects and the internal data validation process prevented the use of more recent data. Available data included demographics, comorbidities, complications, and obstetrics problems.

Postpartum hemorrhage (PPH) was defined as blood loss over 500 ml after vaginal delivery or over 1000 ml after cesarean section. Anemia was defined as Hb value under 11 g/dl in the first and third trimester and under 10.5 g/dl in the second trimester.

There were 38,060 women diagnosed with PAS included in the final analysis, aged a median 31 years. Of participants, 4.66% reported postpartum obstetric hemorrhage, 0.53% intrapartum hemorrhage, and 0.39% prepartum hemorrhage.

Anemia during pregnancy was reported in 23.47% of participants, any other form of anemia in 11.93%, and anemia because of acute bleeding situations in 10.38%. These rates were significantly higher among patients with PAS vs those without PAS, at 60.36% vs 23.25%, 45.98% vs 11.73%, and 43.99% vs 10.18%, respectively.

PPH rates also differed significantly between groups, at 47.08% in the PAS group and 4.41% in the non-PAS group. Other differences included gestational hypertension at 1.42% vs 1.17%, respectively, pre-existing diabetes during pregnancy at 6.76% vs 6.15%, respectively, and median hospital length of stay at 4.21 days vs 3.53 days, respectively.

Administration of blood products was also more common in women with PAS vs those without PAS. Allogeneic RBC transfusion was reported in 14.68% vs 0.72%, respectively, and massive blood transfusion in 0.77% vs 0.02%, respectively.

Women with PAS were significantly more likely to experience anemia when receiving RBC transfusion than those with PAS but not RBC transfusion, at 90.43% vs 55.18%, respectively, for anemia during pregnancy, 92.34% vs 38%, respectively, for any other form of anemia, and 91.93% vs 35.74%, respectively, for anemia because of acute bleeding.

These results indicated increased peripartum complications among women with PAS vs those without PAS, as well as a positive association between RBC transfusion and anemia risk among those with PAS. Investigators concluded it is vital to detect and treat prepartum anemia before delivery in women with PAS.