Objective: The goal of this study is to analyze the clinical manifestation of obstetrical patients who refused transfusion of any blood component. Through this analysis, we could define the guideline of non-blood transfusion treatment during the obstetrical procedure. Methods: 127 patients who visited our non-blood transfusion treatment center and had obstetrical procedures from 1 Jan. 2000 to 31 March 2006 participated in this study. They were retrospectively analyzed according to the following indexes; the reason of refusing blood transfusion, age, ratio of vaginal delivery to Cesarean section, comparison of hemoglobin level, volume of blood loss, presence of bloodless treatment, days of hospitalization, presence of blood transfusion, consequence of patient (including complications and deaths). Bloodless treatment at the hospital are medical method (recombinant human erythropoietin, Aprotinin, Hemocoagulase, Tranexamine acid, Venoferrum), Autotransfusion and Electrocauterization. Results: Among 126 patients (except for 1 patient who was delivered at the other hospital), the vaginal delivery group consisted of 57, and the Cesarean operation group was 69. The most common cause of primary caesarean section was arrest disorder of cephalo-pelvic disproportion. Among 26 patients qualified for indication of transfusion, uterine atony had the highest number of patients at 16. Among the indication of transfusion, low hemoglobin level (≦8.0 g/dL) after operation had the highest number of patients at 20. Patients qualified indication of transfusion had twice more blood loss (464.6±34.2 ml vs 920.5±214.2 ml) and two more days of hospitalization (7.6±0.5 day vs 9.7±0.6 day) compared with those of non-qualified for indication of transfusion. Nobody received direct transfusion of blood component. There were no death but acute renal failure in one patient, and DIC (disseminated intravascular coagulation) in another patient as complications. Conclusions: This study analyzed the clinical manifestations of patients who refused a blood transfusion in obstetrics. Especially, when the non-blood transfusion treatment was performed, which had been an issue in recent times, more active treatment showed less reduction of hemoglobin level than no treatment. This study also confirmed that bleeding patients can be treated by selective non-blood transfusion treatment.

Objective: The goal of this study is to analyze the clinical manifestation of obstetrical patients who refused transfusion of any blood component. Through this analysis, we could define the guideline of non-blood transfusion treatment during the obstetrical procedure. Methods: 127 patients who visited our non-blood transfusion treatment center and had obstetrical procedures from 1 Jan. 2000 to 31 March 2006 participated in this study. They were retrospectively analyzed according to the following indexes; the reason of refusing blood transfusion, age, ratio of vaginal delivery to Cesarean section, comparison of hemoglobin level, volume of blood loss, presence of bloodless treatment, days of hospitalization, presence of blood transfusion, consequence of patient (including complications and deaths). Bloodless treatment at the hospital are medical method (recombinant human erythropoietin, Aprotinin, Hemocoagulase, Tranexamine acid, Venoferrum), Autotransfusion and Electrocauterization. Results: Among 126 patients (except for 1 patient who was delivered at the other hospital), the vaginal delivery group consisted of 57, and the Cesarean operation group was 69. The most common cause of primary caesarean section was arrest disorder of cephalo-pelvic disproportion. Among 26 patients qualified for indication of transfusion, uterine atony had the highest number of patients at 16. Among the indication of transfusion, low hemoglobin level (≦8.0 g/dL) after operation had the highest number of patients at 20. Patients qualified indication of transfusion had twice more blood loss (464.6±34.2 ml vs 920.5±214.2 ml) and two more days of hospitalization (7.6±0.5 day vs 9.7±0.6 day) compared with those of non-qualified for indication of transfusion. Nobody received direct transfusion of blood component. There were no death but acute renal failure in one patient, and DIC (disseminated intravascular coagulation) in another patient as complications. Conclusions: This study analyzed the clinical manifestations of patients who refused a blood transfusion in obstetrics. Especially, when the non-blood transfusion treatment was performed, which had been an issue in recent times, more active treatment showed less reduction of hemoglobin level than no treatment. This study also confirmed that bleeding patients can be treated by selective non-blood transfusion treatment.

목적: 출혈이 유발되는 산과적 시술을 받은 수혈거부 환자들의 임상적 특징을 분석하고 무수혈적 치료 효과를 분석하여 향후 치료시 지표를 확립하고자 하였다.방법: 2000년 1월 1일부터 2006년 3월 31일까지 본원 무수혈 센터를 방문하여 산과적 시술을 받은 환자 중 출산을 목적으로 한 127명을 대상으로 수혈거부이유, 환자의 연령, 분만과 수술비율, 환자의 혈색소치 비교, 실혈량, 무수혈적 치료 여부, 입원기간, 수혈여부, 환자의 결과 (합병증 및 사망여부 포함) 등을 분석하였다. 무수혈적 치료는 약물치료 (재조합 에리쓰로포이에틴, 아프로티닌, 보트로파제, 트라넥삼산, 베노페롬)와 자가수혈, 전기소작술을 이용하였다.결과: 127명 중 1명은 타 병원에서 분만하여 제외하고 126명 중 질식 분만 산모는 57명, 제왕절개산모는 69명이었다. 질식 분만 산모의 나이는 32.2 (±1.3)세이고, 제왕절개 산모의 나이는 33.5 (±1.2)세로 약 1.3세차이가 있었다. 일차 제왕절개술과 이차 이상의 반복제왕절개술의 비율은 비슷하였고, 일차 제왕절개술의 이유는 아두골반불균형에 의한 진행장애가 가장 많았다. 수혈적응 환자 26명 중 자궁무력증이 16명으로 가장 많았고, 수혈적응의 이유는 수술 후 혈색소 수치가 8.0 g/dL 이하로 낮아진 경우가 20명으로 가장 많았다. 수혈적응 환자군이 비적응 환자군보다 입원기간이 2일 더 길며 (7.6±0.5 day vs 9.7±0.6 day) 출혈량도 약 2배 많았으며 (464.6±34.2 ml vs 920.5±214.2 ml) 직접 수혈을 받은 경우는 없었다. 합병증으로 급성 신부전증 1명, 범발성 혈액내 응고장애 1명이었으며 사망한 경우는 없이 퇴원하였다.

수혈거부 환자, 산과적 출혈, 무수혈적 치료