Effectiveness and Clinical Patterns of Iron Supplementation as a Method of Bloodless Treatment in Patients Experiencing Bleeding after Obstetrical Surgery

Background: Some patients refuse blood transfusions despite the risk of hematological complications, such as anemia and iron deficiency, associated with obstetrics treatments and surgery. Therefore, this study aims to investigate the effectiveness and safety of iron supplementation, a major method of bloodless treatment, and retrospectively examine the clinical characteristics and patterns of individuals who underwent bloodless treatment after obstetrical surgery. Methods: We collected medical records of patients who consented to and underwent bloodless treatment between September 2001 and October 2016, and retrospectively analyzed these data. Results: In the vaginal delivery group, 57.1% were nullipara and 42.9% were multipara. Among all patients, 34.9% were not prescribed iron supplements before and after parturition, with 50% and 20.5% of the patients in the vaginal delivery and cesarean groups delivering without being prescribed iron supplements. Of the patients in the cesarean section group, 73.5% were administered iron supplements after parturition compared with only 40.5% in the vaginal delivery group. The mean time from surgery to discharge was 4 days and was significantly longer in the cesarean section group (6 days) than in the vaginal delivery group (2 days). Sixteen patients underwent a hemoglobin test during an outpatient visit at a mean of 48 days after surgery. The cesarean section group exhibited lower hemoglobin levels than the vaginal group on postoperative day (POD) 1. In an examination of changes in hemoglobin levels on POD 1 and before operation, the cesarean section group exhibited reduced hemoglobin levels compared to the vaginal delivery group. Conclusions: Obstetrical procedures, including vaginal delivery and cesarean section, were successfully performed via bloodless treatment in patients for whom substantial blood loss was expected. Thus, bloodless treatment using iron supplements may be a scientific, evidence-based option for patients who refuse blood transfusions.