The Appropriateness of Red Blood Cell Transfusions in the Peripartum Patient
Bibliographic record
Abstract
OBJECTIVE: Despite published guidelines, numerous studies have consistently shown that a significant proportion of red blood cell (RBC) transfusions are unnecessary. The purpose of this study was to evaluate the reasons for and the appropriateness of RBC transfusions in the peripartum patient. METHODS: We reviewed all RBC transfusions given to peripartum inpatients at Sunnybrook and Women's College Health Sciences Centre in Toronto, Ontario, Canada between April 1994 and July 2002. Appropriateness of RBC transfusion was ascertained using current hospital transfusion guidelines. RESULTS: We identified 33,795 obstetrics-related admissions. In 218 admissions (0.65% of all admissions), an RBC transfusion was given to 216 women. There were 83 vaginal deliveries, 94 deliveries by cesarean, and 42 operations (for ectopic pregnancies or dilatation and curettage). A total of 779 RBC units were transfused (median, 2 units per woman; range, 1-32), most commonly for postpartum bleeding (34% of cases). There were 16 adverse events from transfusion recorded. According to guidelines, 248 of the transfused RBC units (32%) were not appropriate. In addition, in 24 patients (11%) the mean corpuscular volume on admission to the hospital for delivery was less than or equal to 80 fL. CONCLUSION: A significant proportion of RBC transfusions given to peripartum women are inappropriate. Educational programs that promote adherence to transfusion guidelines might help reduce exposure to RBC transfusion. Aggressive oral and intravenous iron therapy might have prevented transfusion in 11% of the women in the cohort who were possibly iron deficient.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".