Blood demand and utilization among pregnant and postpartum women with and without HIV infections at the university teaching Hospital, Zambia

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BACKGROUND: Complications from pregnancy, primarily post-partum hemorrhage, including infections like HIV, are the leading causes of maternal mortality in sub-Saharan Africa (SSA). Blood products are not always available for obstetric emergencies because of chronic shortages in SSA countries. Understanding the quantity of blood products used by pregnant and post-partum women with and without HIV infections could inform strategies for the appropriate use of blood in resource-limited settings. METHODS: A prospective study was conducted of medical charts of all pregnant or postpartum (42 days following delivery) women who presented to the obstetrics ward at the University Teaching Hospital (UTH) Zambia and had blood ordered during their hospital stay from November 2016 to March 2017. Abstracted data from the requisition forms included age, hospital ward, clinical indication for blood transfusion, transfusion history, pregnancy history, blood components requested, number of units requested, and date and time of the request. Data extracted from blood bank records included blood issue date, number of units issued, and pre-transfusion hemoglobin. Variables extracted from the patient's chart included age, HIV status, pregnancy history, blood component transfused, delivery method, labor complications, and transfusion outcome/adverse events. RESULTS: A total of 1086 blood requests and charts of women were reviewed in the study at UTH. Blood requests for women living with HIV (WLHIV) and women without HIV infection were 265 (24.4%) and 821 (75.6%), respectively. Of the 1034 blood requests received, WLHIV represented 40.2% (103) of antepartum (n = 256) requests and 38.9% (n = 303) of postpartum (n = 778) blood requests. Of the 43% (465) women who received a transfusion, 47.1% (125) were WLHIV and 41.4% (340) were women without HIV infection. Pregnancy-related indications for transfusion in WLHIV were other 92 (34.7%), postpartum hemorrhage 26 (9.8%), complications of ectopic pregnancy 23 (8.6%), acute anemia 11 (4.1%), placenta abruption 8 (3.0%), uterine rupture 3 (1.1%), disseminated intravascular coagulation (DIC) and HELLP syndrome 1 (0.3%). CONCLUSION: HIV infection's contributory role in blood demand and use among pregnant women in Zambia may be smaller than previously thought. However, findings suggest that continued investments in hemovigilance and appropriate blood use within the clinical setting could improve rational blood use in low-resource settings and maternal outcomes.

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