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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Traditional versus New Transfusion Protocol for Obstetric Hemorrhage. Which is better?

Abstract Number: 6
Abstract Type: Original Research

Neeti Sadana MD1 ; Michaela Farber MD2; Richard Kaufman MD3; Bhavani Shankar Kodali MD4

Military experience in trauma resuscitation, and anecdotal experience during aortic aneurysm surgical hemorrhage suggest that mortality decreases with the use of red blood cell (RBC) and fresh frozen plasma (FFP) transfusions in a ratio of 1:1 compared to the traditional ratio of 3:1 (1-3). Many similarities exist between maternal and traumatic hemorrhage. It is logical to extend this novel recommendation to massive obstetric hemorrhage. However, to date no obstetric study has evaluated this approach. This in vitro study is designed to investigate the efficacy of 1:1 versus 3:1 RBC to FFP transfusion ratios in a simulated obstetric hemorrhage model using thromboelastography (TEG).

METHODS: After obtaining IRB approval, 12 ml venous blood samples were drawn from 15 healthy parturients in early labor or prior to elective cesarean delivery. Baseline TEG variables (r time (min), k time (min), alpha angle (degrees) and maximum amplitude (mm)) were determined using the Hemoscope 5000 model (a). The remaining blood was diluted with equal volumes of 0.9% normal saline. One ml of this sample was used to determine diluted TEG variables (b). The remaining diluted sample was further divided into two equal parts. In 10 patients, RBC and FFP were added in a 1:1 ratio to one diluted sample (c) and 3:1 to the other (d). Fifty percent of the final volume was the additional combination. In 5 additional patients, the study was repeated except that platelets (38% by volume) were also added to the RBC and FFP combination (e,f). Aliquots of O negative packed cells, FFP and platelets were obtained from the Blood Bank. Baseline and reconstituted samples were analyzed for hematocrit and platelet count. All variables were analyzed for statistical significance (P<0.05) using the Bonferroni ANOVA method.

RESULTS: Diluted blood samples resulted in a significant decrease in clot strength (MA) (P < 0.05). Addition of either a 1:1 or 3:1 RBC:FFP combination did not restore the MA (MA significantly lower compared to baseline). However, the

addition of platelets increased MA towards baseline MA values in the1:1 group (P=ns from baseline).

CONCLUSION: This in vitro model of obstetric hemorrhage suggests that the 1:1 RBC:FFP ratio is a better approach only if the platelets are adequate in number. Further study will evaluate coagulation dynamics in less diluted states.


1. J Trauma 2007;63: 805-813.

2. J Trauma. 2008;65:986-983.

3. Transfusio

SOAP 2010