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Retrospective Study of Massive Transfusion Protocol Activation and Usage at a Large Obstetric Center.
Abstract Number: 41
Abstract Type: Original Research
Introduction: A massive transfusion protocol (MTP) offers major advantages for the management of patients with postpartum hemorrhage (PPH)(1). There is limited clinical data associated with MTP activation in an obstetric setting (2). We retrospectively evaluated indications, transfusion outcomes and laboratory indices in obstetric cases requiring MTP activation.
Methods: After IRB approval, we reviewed medical records of obstetric patients that required MTP activation at our institution between 01/01/08-07/31/10. We abstracted demographic, obstetric, transfusion and laboratory data [Hb, PT, PTT, blood gases]). Maternal outcomes were also assessed post-transfusion.
Results: MTP activation occurred in 31 patients (0.26% of deliveries during that period). 19 patients (61%) patients had cesarean delivery, 10 patients (32%) had vaginal delivery, and 2 patients (7%) had dilation and evacuation. The etiologies of PPH requiring MTP activation, blood product usage and ‘most extreme’ laboratory values are shown in Table. Of the 31 patients, 4 (13%) received no MTP products; 4 patients (13%) received between 6-12 units PRBC and 4-8 units FFP/liquid plasma; 2 patients (7%) received >12 PRBC and >8 units FFP. Four patients (13%) received > 2 units of platelets. Most patients (87%) were type and screened prior to the event, and 15 patients (48.4%) were type and crossed. Obstetric postpartum morbidity included: ICU admission in 19 patients (61%) [median ICU duration=1 day]; 8 (26%) patients required ventilation post-transfusion; 6 patients (19%) required hysterectomy. Only 1 patient had MTP activation without receiving any transfusion (due to PPH [2500 mL] with stable Hb values >8g/dL).
Discussion: The indications for MTP activation in our study were heterogeneous, with uterine atony and abnormal placentation as common etiologies. A subgroup of patients benefited from early availability and ongoing supplies of blood products provided by our MTP. The ‘most extreme’ and post transfusion laboratory values were not excessively deranged, suggesting that early blood product availability due to MTP activation may improve post-transfusion hematologic outcomes. Further studies are needed to formally assess the clinical value of MTP versus ‘standard of care’ in an obstetric setting.
References: (1)Transfusion 2007; 47:1564-1572. (2)Int J Obstet Anesth 2009;18: 302-308.