Emergency-release blood transfusions after postpartum hemorrhage at the Intermountain Healthcare hospitals.
Transfusion
; 60(7): 1418-1423, 2020 07.
Article
em En
| MEDLINE
| ID: mdl-32529673
ABSTRACT
BACKGROUND:
Most low-risk obstetric patients do not have crossmatched blood available to treat unexpected postpartum hemorrhage. An emergency-release blood transfusion (ERBT) program is critical for hospitals with obstetrical services. We performed a retrospective analysis of obstetrical ERBTs administered in our multihospital system. DESIGN ANDMETHODS:
We collected data from the past 8 years at all Intermountain Healthcare hospitals on every ERBT after postpartum hemorrhage; logging circumstances, number and type of transfused products, and outcomes.RESULTS:
Eighty-nine women received ERBT following 224,035 live births, for an incidence of 3.97 transfused women/10,000 births. The most common causally-associated conditions were uterine atony (40%), placental abruption/placenta previa (16%), retained placenta (11%), and uterine rupture (5%). The mean number of total units transfused was 7.9 (range 1-76). The mean number of red blood cells (RBCs) transfused was 4.8, the median 4, and SD was ±4.4. Massive transfusion protocols (MTPs) for trauma recommend using a ratio of 111 or 211 of RBCFFPPlatelets, however the ratios varied widely for postpartum hemorrhage. Only 1.5% received a 111 ratio and 7.5% received a 211 ratio. Nineteen percent (17/89) of women underwent hysterectomy, 7% (6/89) had uterine artery embolization, 36% (32/89) had an intensive care unit admission, and 1% (1/89) died.CONCLUSION:
Emergency transfusion for postpartum hemorrhage occurred after 1/2500 births. Most women received less FFP and platelets than recommended for traumatic hemorrhage. A potentially better practice for postpartum hemorrhage would be a balanced ratio of blood products, transfusion of low-titer, group O, cold-stored, whole blood, or inclusion in a MTP.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Plasma
/
Transfusão de Plaquetas
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Transfusão de Eritrócitos
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Serviços Médicos de Emergência
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Hemorragia Pós-Parto
/
Hospitais
Tipo de estudo:
Etiology_studies
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Transfusion
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Estados Unidos