Emergency‐release blood transfusions after postpartum hemorrhage at the Intermountain Healthcare hospitals. Issue 7 (11th June 2020)

• Record Type: Journal Article
• Authors: Hulse, Whitley; Bahr, Timothy M.; Morris, David S.; Richards, Douglas S.; Ilstrup, Sarah J.; Christensen, Robert D.
• Is Part Of: Transfusion. Volume 60:Issue 7(2020)
• Page Start: 1418
• Page End: 1423
• Publication Date: 2020-06-11
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.15903
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract : BACKGROUND: Most low‐risk obstetric patients do not have crossmatched blood available to treat unexpected postpartum hemorrhage. An emergency‐release blood transfusion (ERBT) program is critical for hospitals with obstetrical services. We performed a retrospective analysis of obstetrical ERBTs administered in our multihospital system. DESIGN AND METHODS: We collected data from the past 8 years at all Intermountain Healthcare hospitals on every ERBT after postpartum hemorrhage; logging circumstances, number and type of transfused products, and outcomes. RESULTS: Eighty‐nine women received ERBT following 224, 035 live births, for an incidence of 3.97 transfused women/10, 000 births. The most common causally‐associated conditions were: uterine atony (40%), placental abruption/placenta previa (16%), retained placenta (11%), and uterine rupture (5%). The mean number of total units transfused was 7.9 (range 1‐76). The mean number of red blood cells (RBCs) transfused was 4.8, the median 4, and SD was ±4.4. Massive transfusion protocols (MTPs) for trauma recommend using a ratio of 1:1:1 or 2:1:1 of RBC:FFP:Platelets, however the ratios varied widely for postpartum hemorrhage. Only 1.5% received a 1:1:1 ratio and 7.5% received a 2:1:1 ratio. Nineteen percent (17/89) of women underwent hysterectomy, 7% (6/89) had uterine artery embolization, 36% (32/89) had an intensive care unit admission, and 1% (1/89) died. CONCLUSION: Emergency transfusion for postpartum hemorrhage occurred after 1/2500 births. Most women received less FFP and platelets than recommended for traumatic hemorrhage. A potentially better practice for postpartum hemorrhage would be a balanced ratio of blood products, transfusion of low‐titer, group O, cold‐stored, whole blood, or inclusion in a MTP.