Retrospective study to investigate fresh frozen plasma and packed cell ratios when administered for women with postpartum hemorrhage, before and after introduction of a massive transfusion protocol. (November 2018)

• Record Type: Journal Article
• Authors: Weiniger, C.F.; Yakirevich-Amir, N.; Sela, H.Y.; Gural, A.; Ioscovich, A.; Einav, S.
• Is Part Of: International journal of obstetric anesthesia. Volume 36(2018)
• Page Start: 34
• Page End: 41
• Publication Date: 2018-11
• Subjects: Fixed ratio -- Fresh frozen plasma -- Obstetrics -- Postpartum hemorrhage -- Transfusion protocol; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2018.08.001
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Obstetric massive transfusion protocols (MTP) suggest fixed 1:1 blood product ratios. We compared transfusion practice before and after protocol introduction. Blood product transfusion ratios were similar before and after introduction. As more packed red blood cells were administered, transfusion ratios reached 1:1. Factors other than MTP may influence the blood product transfusion ratios. Abstract: Background: Administration of packed red blood cells (PRBC) and fresh frozen plasma (FFP) to women with postpartum hemorrhage (PPH) before and after introduction of a massive transfusion protocol. Methods: The retrospective PPH study cohort of two tertiary centers was identified using blood bank records, verified by patient electronic medical records. We identified women transfused with ≥3 units PRBC in a short time period within 24 hours of delivery. Since 2010, both centers have used a protocol using 1:1 FFP:PRBC ratios. Demographic, obstetric, and blood management data were retrieved from medical records. Outcome measures included estimated blood loss, blood product administration, and hematologic variables. Results: 273 women were included, 112 (41.0%) prior to introduction of the protocol (2004–2009) and 161 (59.0%) afterwards (2010–2014). The frequency of women managed with 1:1 FFP:PRBC ratios was similar before 55/112 (49.1%) and after 83/161 (51.6%) introduction of the protocol ( P =0.69). There was strong correlation between PRBC units transfused and the FFP:PRBC transfusion ratio (R-square 0.866, P <0.0001), demonstrating that as the number of transfused PRBC units increased, FFP:PRBC ratios became closer to 1:1. There were no outcome differences between women managed before and after introduction of the protocol. Conclusions: Among women with PPH receiving ≥3 PRBC units within a short period of time, it appears that factors other than the existence of our massive transfusion protocol influence the number and ratio of PRBC and FFP units transfused. Blood products were not transfused according to exact ratios, even when guided by a protocol.