Postpartum IV iron sucrappenose, and rates of RBC transfusion: A quality improvement initiative

Transfusions of packed red blood cells (RBC) have long been used to correct postpartum anaemia. Given the ongoing shortage of packed RBC and transfusion reactions, we sought to determine if the use of IV iron sucrose infusions could decrease transfusions in the postpartum period.

We conducted a six-year quasi-experimental interrupted time series study from January 2016 to December 2021. The study was divided into three phases: 1. pre-intervention phase, 2. roll-out phase, and 3. post-intervention phase. Our intervention focused on a holistic transfusion prevention bundle that incorporated provider education regarding transfusion practices, antepartum optimization, and cell saver use. The main outcome was change over time from the use of IV iron sucrose over allogenic blood products in the setting of postpartum anaemia. Statistical process control (SPC) was used to explore the effect of our bundled intervention over time.

46 478 deliveries were recorded. The XmR control chart showed a shift between phases 1 and 3, as indicated with a special cause signal. The U control chart demonstrated that IV iron infusions increased from 5.6 per 1000 births in phase 1 to 136.4 per 1000 births in phase 3. On Poisson regression, the rate of IV iron sucrose infusions increased 19-fold [RI 19.65 (95% CI 16.00-24.14 p < 0.0001)], while the rate of transfusions decreased by 60% [RI 0.4 (95% CI 0.33-0.49 p < 0.001)] from pre- to post-intervention.

A holistic transfusion prevention bundle was associated with both a reduction in the number of patients transfused and the rate of multiple-unit RBC transfusions.