Transfusion rate and prevalence of unexpected red blood cell alloantibodies in women undergoing hysterectomy for benign disease.

OBJECTIVE: To determine transfusion rates, risk factors for transfusion and the prevalence of unexpected red blood cell alloantibodies in women undergoing hysterectomy for benign disease. In addition, we aimed to evaluate the necessity of the pretransfusion testing for red blood cell alloantibodies. DESIGN: Retrospective cohort study. SETTING: The Danish Hysterectomy Database and a regional computerized blood bank register. POPULATION: The 4 181 hysterectomies in 2004 reported to the Hysterectomy Database. The blood bank registers 2 603 hysterectomies performed between 1997 and 2005. METHODS: From the hysterectomy database, information about indications for the hysterectomy, surgical procedures, re-operations, number of blood transfusions, and demographic, descriptive and clinical characteristics were extracted. Urgency of the transfusion episodes was evaluated by a retrospective review of the patients' medical records. From the regional blood bank register, results of the screening for red blood cell alloantibodies were extracted. MAIN OUTCOME MEASURES: Transfusion rates, prevalence of unexpected red blood cell alloantibodies. RESULTS: In all, 242 women (5.8%) received blood transfusions, but only 32 of the 4 181 women (0.77%) were urgently transfused. Re-operations were frequently associated with urgent blood transfusions. Nine of the 2 603 women from the regional register (0.35%) had newly detected, clinically significant red blood cell alloantibodies. CONCLUSIONS: The risk of a hemolytic transfusion reaction was estimated to be less than 1 in 17 000 hysterectomies (upper confidence limit) if the routine pretransfusion test were to be omitted. We suggest that reconsideration of the necessity for routine preoperative pretransfusion testing for women undergoing hysterectomy for benign disease is indicated.

Cervical adenosquamous carcinoma: tumor implantation in an episiotomy scar.

BACKGROUND: We report a rare case of a cervical adenosquamous carcinoma, initially diagnosed during delivery, with subsequent implantation in the episiotomy scar 5 weeks postpartum. CASE: A 35-year-old woman with cervical adenosquamous carcinoma diagnosed during delivery was treated with radical abdominal hysterectomy with bilateral pelvic lymphadenectomy. Five weeks later the metastatic tumor at the episiotomy site was excised, and the patient received adjuvant chemotherapy and radiation therapy. Relapse occurred rapidly, and surgical exenteration was initiated but abandoned intraoperatively due to the presence of intra-abdominal carcinomatosis. The patient was declared terminal 6 months postpartum and died 2 months later. CONCLUSION: This case illustrates the importance of inspection of the perineal area during delivery in patients diagnosed with cervical cancer.