Rationale for blood transfusion in obstetrics

By:

Sajjad, N

Contributor(s):

Fakokunde, A

Publication details: 2015Uniform titles:

BJOG

Online resources:

Summary: Introduction Following the improvement in maternal mortality rates, now it is time to reduce morbidity in obstetrics. Current practice to manage massive obstetrics haemorrhage is to transfuse large volumes of red blood cell prior to transfusion of blood products (4:2). Transfusion of clotting factors is driven by the coagulation screen results. Data from trauma patients show that plasma transfusion at 1:1 to red blood cells is associated increased survival of the patients especially within the first 24 hours of the injury. Method We collected data from the blood bank of all the cases where blood was cross matched and transfused during 1 June 2013 to 5 January 2014. Total cases identified (n = 144) and retrieved and reviewed (n = 112). The data separated into two groups: A <1500 mL and group B >1500 mL. Results Group A the number of deliveries with blood loss <1500 mL (n = 84). Average blood lost 729 mL. Baseline haemoglobin 10.8 g/dL and before blood transfusion 7.8 g/dL. Haemoglobin after blood transfusion 9.1 g/dL. Ratio of blood and blood products transfused not applicable as mainly red blood cells transfused. Primigravida were identified as the at risk group for blood transfusion. Due to active management of third stage of labour the multigravida are at lower risk of postpartum haemorrhage and blood transfusion. Group B the number of deliveries with blood loss >1500 mL (n = 28). Average blood loss 1947 mL. Baseline haemoglobin 11.2 g/dL and before blood transfusion 6.9 g/dL. Haemoglobin after blood transfusion 9.5 g/ dL. Ratio of blood and blood products transfused 4:3. Conclusion PPH <1500 mL should not require blood transfusion due to the haemodynamic changes in pregnancy. Improving the antenatal haemoglobin will reduce the risk of blood transfusion. PPH >1500 mL we noted that there was a large amount of red blood cells transfused before transfusing the blood products. This increasing the risk of disseminated intravascular coagulation and maternal morbidity. Hence if we start the transfusion of the blood and blood products earlier with a ratio of 1:1, this could lead to reduction in disseminated intravascular coagulation and reduce intensive care admission. (Conference abstract)

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Introduction Following the improvement in maternal mortality rates, now it is time to reduce morbidity in obstetrics. Current practice to manage massive obstetrics haemorrhage is to transfuse large volumes of red blood cell prior to transfusion of blood products (4:2). Transfusion of clotting factors is driven by the coagulation screen results. Data from trauma patients show that plasma transfusion at 1:1 to red blood cells is associated increased survival of the patients especially within the first 24 hours of the injury. Method We collected data from the blood bank of all the cases where blood was cross matched and transfused during 1 June 2013 to 5 January 2014. Total cases identified (n = 144) and retrieved and reviewed (n = 112). The data separated into two groups: A &lt;1500 mL and group B &gt;1500 mL. Results Group A the number of deliveries with blood loss &lt;1500 mL (n = 84). Average blood lost 729 mL. Baseline haemoglobin 10.8 g/dL and before blood transfusion 7.8 g/dL. Haemoglobin after blood transfusion 9.1 g/dL. Ratio of blood and blood products transfused not applicable as mainly red blood cells transfused. Primigravida were identified as the at risk group for blood transfusion. Due to active management of third stage of labour the multigravida are at lower risk of postpartum haemorrhage and blood transfusion. Group B the number of deliveries with blood loss &gt;1500 mL (n = 28). Average blood loss 1947 mL. Baseline haemoglobin 11.2 g/dL and before blood transfusion 6.9 g/dL. Haemoglobin after blood transfusion 9.5 g/ dL. Ratio of blood and blood products transfused 4:3. Conclusion PPH &lt;1500 mL should not require blood transfusion due to the haemodynamic changes in pregnancy. Improving the antenatal haemoglobin will reduce the risk of blood transfusion. PPH &gt;1500 mL we noted that there was a large amount of red blood cells transfused before transfusing the blood products. This increasing the risk of disseminated intravascular coagulation and maternal morbidity. Hence if we start the transfusion of the blood and blood products earlier with a ratio of 1:1, this could lead to reduction in disseminated intravascular coagulation and reduce intensive care admission.&nbsp;(Conference abstract)

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