Epigenetic Associations and Risk Factors for Blood Transfusion in Women undergoing Laparoscopic Myomectomy: A Review

Abstract

Background: Laparoscopic myomectomy is a minimally invasive surgical procedure used to remove uterine fibroids. While generally associated with reduced recovery times and fewer complications compared to open surgery, the risk of blood transfusion remains a significant concern. Methodology:  This narrative review aims to identify risk factors associated with intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool based on available literature. A comprehensive examination of studies published between July 2015 and February 2024 was conducted using databases such as MEDLINE, ScienceDirect, CINAHL, and PubMed. The search focused on MeSH terms including 'blood transfusion,' 'laparoscopic myomectomy,' 'uterine fibroids,' and 'perioperative care.' After eliminating duplicates, a total of 8 articles were selected for detailed analysis. Results: Our findings indicate that several demographic and clinical characteristics, including race, preoperative hematocrit levels, and surgical approach, significantly influence the likelihood of requiring a blood transfusion. African American and Hispanic patients were identified as having a higher risk, with preoperative anemia and elevated American Society of Anesthesiologists (ASA) classifications further contributing to increased transfusion rates. The presence of bleeding disorders, larger specimen weights, and prolonged operation times also emerged as key risk factors. The review highlights the need for tailored preoperative assessments, particularly for high-risk demographics, to mitigate transfusion risks. Additionally, preoperative interventions such as correcting anemia and considering uterine artery embolization (PUAE) may help reduce intraoperative blood loss and the subsequent need for transfusion. Although the developed predictive model demonstrates moderate accuracy, further validation in clinical settings is necessary. Implementing such a model in preoperative evaluations could enhance patient outcomes by identifying high-risk patients and enabling the implementation of preventive measures. Conclusion: Understanding and addressing the identified risk factors are crucial for optimizing surgical outcomes and reducing the need for blood transfusions in women undergoing laparoscopic myomectomies. Further research is recommended to validate these findings and refine risk stratification tools for clinical use.