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Is the transfusion of whole blood better for resuscitation in cesarean delivery? A Retrospective analysis of the transfusion of whole blood versus component therapy during cesarean delivery.
Abstract Number: T110-490
Abstract Type: Original Research
The rate of postpartum hemorrhage has risen dramatically, along with a rise in blood transfusion rates. The rate of cesarean delivery has increased drastically in the past decade and is well over 30% in the USA. Subsequently, there is the added risk of abnormal placentation, which can contribute to maternal and fetal morbidity and mortality via placenta accreta, increta, and percreta. Whole blood (WB) contains all of the individual blood components,yet there are concerns for the use of WB including the efficacy of platelet after cold storage, the risk of transfusion reaction from un-cross matched WB, and the logistical issues. The primary aim of the study is to compare the average number of overall units transfused in patients receiving WB versus component therapy (CT) during hospital stay. Secondary aim is to compare the incidence of 3 common adverse outcomes: Renal failure, Heart failure, and Transfusion-related lung disease in patients receiving WB vs. CT.
Results:Our study consists of retrospective analysis of all subjects who underwent C-sections and received a blood transfusion at Parkland Hospital L&D Unit during 01/01/2010 through 12/01/2016. Exclusion criteria included pre-existing coagulation abnormalities, renal failure, peripartum cardiomyopathy, or acute lung injury, and patients who underwent Massive Transfusion Protocol intraoperatively. Approximately 1500 subjects were included in the study with preliminary analysis of 296 subjects. Subjects were divided into 3 groups according to blood product given: only (WB) (n=121), only (CT) (PRBCs, Platelet, FFP, or Cryo) (n=82), or Both WB + CT (n=93). On average, patients in the WB group were transfused 2.365 (SD= 0.872) units of WB. Patients in the CT group were transfused 4.306 (SD= 1.705) units of PRBCs and 0.047 (SD= 0.263) units of platelets. Patients in the combination group (both WB and CT) were transfused 3.198 (SD = 1.769) units of WB, 3.979 (SD= 3.725) units of PRBCs, 0.521 (SD= 1.187) units of FFP, 0.135 (SD = 0.690) units of platelets, and 0.729 (SD= 5.281) units of Cryo. Acute renal failure was seen in 0.34% of subjects in WB group and 1.01% of subjects in CT group. Respiratory failure was seen in 1.0% of patients in WB group and 0.33% of patients in CT group. Heart failure was not experienced in either group.
Conclusion:The preliminary results reveal a decreased number of units transfused in patients receiving WB vs. CT. The data regarding complication rates is currently inconclusive (P>.05) due to the limited study size. Analysis of the entire study population (n=1500) will allow testing for a 15% difference between the mean numbers of units transfused with 80% power and a level of significance of 0.05. We hypothesize fewer complications in the WB group providing potential advantages in managing serious obstetric hemorrhage.
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