Rapid release of blood products for obstetric hemorrhage: does it make a difference?
Abstract Number: 58
Abstract Type: Original Research
Background: The management of severe postpartum hemorrhage (PPH) often involves transfusion of blood products including packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. Transfusion decisions in this setting are often made empirically, since systematic evidence for practice guidelines is limited (1). Physicians typically underestimate, rather than overestimate, blood loss, often resulting in delays in initiation of blood transfusion (2). In April of 2007, a large obstetric center implemented the use of rapid release blood products specifically for obstetric hemorrhage. We performed a retrospective study 2 years before and 2 years after the rapid release system was started at the hospital, comparing transfusion practice and outcomes in postpartum patients.
Methods: A retrospective, observational study was performed of obstetric inpatients who received red blood cell transfusion and/or blood products over a time period of 4 years: 2 years before ("Pre") and 2 years after ("Post") a rapid release system for blood products was implemented for obstetric hemorrhage. Data abstracted included transfusion data, pre-transfusion hemoglobin (Hgb), lowest recorded (nadir) Hgb, and maternal outcomes.
Results: During the study period, 4% of parturients received transfusion therapy. In the Pre group, pre-transfusion and nadir Hgb values were 11.9 g/dL and 8.2 g/dL, respectively. In the Post group, pre-transfusion and nadir Hgb values were 11 g/dL and 7.8 g/dL, respectively. The mean of packed red blood cells transfused in the Pre and Post groups was 2.8 and 4.7 respectively. Mean fresh frozen plasma transfused in the Pre group was 0.55, compared to the Post group mean of 2.0. The Pre FFP/PRBC ratio mean was 0.129 while the Post ratio was 0.34.
Conclusion: The implementation of a new protocol for rapid release of blood products in the setting of obstetric hemorrhage resulted in the following practice changes: mean transfusion volume for both PRBCs and FFP increased, as did the FFP/RBC ratio. We need to analyze more data to be certain whether the change improved patient outcomes. We conclude that the change in transfusion policy apparently made blood products more available and led to increased transfusion of fresh frozen plasma.
1. Semin Perinatol 33: 124-7, 2009.
2. Obstet Gynecol 108: 1039-47, 2006.