Intravenous Iron Sucrose Infusions Reducing Postpartum Blood Transfusion: A Quality Improvement Initiative

A quality improvement initiative to determine if increased use of Intravenous Iron sucrose infusion was associated with a decreased usage of red blood cell transfusions in the postpartum period. From January 2016-December 2021, we initiated best practices of two components: 1) optimization of peripartum anemia by monthly hemorrhage report, routine postpartum use of IV iron, audits of pre-operative charts to hemoglobin optimization before scheduled cesarean birth 2) discouraging routine transfusions of blood products and routine use of more than one unit of packed red blood cells. The intervention rollout period was 2018- 2020. Statistical Process Control Run and Control Charts were created by JMP Pro 16. A generalized mixed linear model was used to predict the number of transfusions per number of live births (binomially distributed) from infusion rate and hemorrhage rate. Between January 2016 to December 2021, 28,457 deliveries were recorded. The Statistical Process (SPC) Run Chart and Control U Chart show a shift during phase analysis. The average total transfusions per 1000 births in Pre-Intervention phase (2016-2017) was 15.4. This decreased to 14.0 transfusions during the rollout phase (2018-2019) and further decreased to 6.2 transfusions per 1000 births in the post-intervention phase (2020-2021). The average total number of Iron Infusions per 1000 births increased from 5.6 in the pre-intervention phase to 136.4 in the post-intervention phase. Spearman correlation between transfusion and infusion rate was −0.48 (95% confidence interval [−0.64, − 0.28], p< 0.001). The rate of 1-unit transfusion of all transfusions increased from 15% in 2018 to 56% in 2021. Protocols with multifaceted intervention to reduce red blood cell transfusion, including intravenous Iron Sucrose Infusion, could safely reduce the rate of red blood cell transfusion during the postpartum period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)