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Poster Session 2

(458) Predicting the need for Blood Transfusion Based on CBC at admission in Normal Vaginal Delivery

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Daniel Gabbai, MD, MPH

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

    • Coauthor(s)

  • Itamar Gilboa, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

  • AL

    Anat Lavie, MD

    Tel Aviv Sourasky Medical Center
    Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • YY

    Yariv Yogev, MD

    Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University
    Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • Emmanuel Attali, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

Objective:

The relationship between admission complete blood count (CBC) parameters, specifically the Neutrophil-to-Lymphocyte Ratio (NLR), and the requirement for packed red blood cell (pRBC) transfusion following vaginal delivery remains underexplored. This study aims to investigate the association between various CBC parameters, including NLR, and the need for pRBC transfusion, and to evaluate their predictive value for this outcome.



Study Design: A retrospective cohort study was conducted at a tertiary, university-affiliated medical center with about 12,500 annual deliveries (2012-2023). Women were categorized based on the need for blood transfusion, determined by severe ongoing haemorrhage, symptomatic anemia with Hb levels of 7–8 g/dL, or postpartum Hb levels < 7 g/dL. Maternal demographics, CBC characteristics at admission, and delivery outcomes were analyzed. Multivariate logistic regression identified predictors for pRBC transfusion, and a risk prediction score was developed and evaluated using the ROC curve

Results:

  1.  During the study period, 145,833 women delivered in our center. The CBC parameters of 37,631 women who delivered vaginally were available. Of them, 957 (2.5%) required pRBC transfusion.

  2. Advanced maternal age, nulliparity, and conception by IVF were associated with increased pRBC transfusion. In contrast, spontaneous onset of delivery (compared to induction) was associated with a lower likelihood of transfusion.

  3. Regarding admission CBC parameters, Hemoglobin < 10.5 g/dL (OR: 6.8, 95% CI: 5.8-8.02, p< 0.001) and Neutrophil to Lymphocyte Ratio (NLR) > 5 (OR: 1.55, 95% CI: 1.3-1.87, p=0.001) were associated with an increased rate of pRBC transfusion.

  4. A scoring model, using a cutoff of 6 [Table 1], successfully predicted blood cell transfusion with an area under the curve of 0.78 (95% CI: 0.75-0.79, p-value < 0.001), achieving 85% sensitivity and 77% specificity. (Figure 1]



Conclusion: CBC parameters, especially hemoglobin and NLR, along with maternal factors, are valuable predictors for the need of pRBC transfusion in vaginal deliveries.