Potential overuse of routine postpartum CBC

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1. Elimination of routine postpartum CBC was associated with decreased CBC use and decreased transfusion rates. 

2. Elimination of routine postpartum CBC was associated with significant cost savings. 

Evidence Rating Level: 3 (Average)       

Study Rundown: This study found that elimination of routine postpartum CBCs was associated decreased use of CBCs and decreased rate of transfusions with significant cost savings. Prior work has identified clinical outcomes, including postpartum hemorrhage and symptomatic anemia, as predictors of transfusion but research has not investigated whether laboratory criteria serve as useful predictors. Findings from this investigation suggest that continued reliance on clinical outcomes combined with a more purposeful use of CBCs decreases transfusion events and cost without additional adverse bleeding events.

Limitations include a case-control design and short follow-up times. Additionally the historical design of the study creates the opportunity for confounding whereby changes in practice or other factors occurring during the second study period may have independently decreased transfusion rates. Reproduction of results in a prospective investigation with longer follow-up would allow for determination of useful clinical markers such as number needed to treat (to prevent unnecessary transfusion) and number needed to harm (to result in adverse events attributable to anemia) with implementation of a stricter laboratory policy.

Click to read the study in AJOG

Relevant Reading: Evaluation of routine antepartum and postpartum blood counts

In-Depth [case-control study]: This historical case-control study compared transfusion rates in postpartum women one year before (n=200) and after (n=200) a policy change was made in 2010 to eliminate routine postpartum CBCs at a tertiary medical center. Outcomes evaluated include transfusion rate, CBC use, adverse bleeding events and cost savings.

For the non-routine CBC group, CBC use and transfusion rates were both decreased (p<0.0001 and p=0.007 respectively). Women in this group were less likely to receive a transfusion (OR 0.30, CI 0.12-0.72). Tachycardia, oliguria and symptomatic anemia were more common among women receiving transfusions (p≤0.001). Overall estimated yearly cost savings was $58,222.

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