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

2018 ◽  
Vol 36 ◽  
pp. 34-41 ◽  
Author(s):  
C.F. Weiniger ◽  
N. Yakirevich-Amir ◽  
H.Y. Sela ◽  
A. Gural ◽  
A. Ioscovich ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postpartum Hemorrhage ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Massive Transfusion Protocol ◽  
Before And After ◽  
Fresh Frozen ◽  
Transfusion Protocol ◽  
Frozen Plasma

Massive Transfusion Protocols in Obstetric Hemorrhage: Theory versus Reality

2021 ◽  
Author(s):  
Bahram Salmanian ◽  
Steven L. Clark ◽  
Shiu-Ki R. Hui ◽  
Sarah Detlefs ◽  
Soroush Aalipour ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Laboratory Evaluation ◽  
Blood Products ◽  
Massive Transfusion Protocol ◽  
Fresh Frozen ◽  
Transfusion Protocol ◽  
Frozen Plasma

Objective Massive transfusion protocols are widely implemented in obstetrical practice in case of severe hemorrhage; however, different recommendations exist regarding the appropriate ratios of blood product components to be transfused. We report our extensive experience with massive component transfusion in a referral center in which the standard massive transfusion protocol is modified by ongoing clinical and laboratory evaluation. Study Design A retrospective chart review of all patients who had massive transfusion protocol activation in a level 4 referral center for obstetrical practice was performed from January 2014 to January 2020. Data collected included the etiology of obstetrical hemorrhage, number of blood products of each type transfused, crystalloid infusion, and several indices of maternal morbidity and mortality. Data are presented with descriptive statistics. Results A total of 62 patients had massive transfusion protocol activation, of which 97% received blood products. Uterine atony was found to be the most common etiology for massive hemorrhage (34%), followed by placenta accreta spectrum (32%). The mean estimated blood loss was 1,945 mL. A mean of 6.5 units of packed red blood cells, 14.8 units of fresh frozen plasma and cryoprecipitate, and 8.3 units of platelets were transfused per patient. No maternal deaths were seen. Conclusion The ratios of transfused packed red blood cell to fresh frozen plasma/cryoprecipitate and of packed red blood cell to platelet units varied significantly from the fixed initial infusion ratio called for by our massive transfusion protocol resulting in universally favorable maternal outcomes. When rapid laboratory evaluation of hematologic and clotting parameters is available, careful use of this information may facilitate safe modification of an initial fixed transfusion ratio based on etiology of the hemorrhage and individual patient response. Key Points

scholarly journals Bleeding Pelvic Fracture Patients: Evolution of Resuscitation Protocols

2017 ◽  
Vol 106 (3) ◽  
pp. 255-260 ◽  
Author(s):  
T. Söderlund ◽  
T. Ketonen ◽  
L. Handolin
Keyword(s):  
Pelvic Fracture ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Standardized Mortality Ratio ◽  
Massive Transfusion Protocol ◽  
Fresh Frozen ◽  
Mortality Ratio ◽  
Group 2 ◽  
Transfusion Protocol

Background and Aims: Massive transfusion protocol seems to improve outcome in massively bleeding trauma patients, but not pelvic fracture patients. The aim of this study was to evaluate the effect of massive transfusion protocol on the mortality and fluid resuscitation of shocked pelvic fracture patients. Material and Methods: This is a trauma register study from a single hospital. From the trauma registry patients with pelvic fracture, injury severity score >15, admission base excess below −5, age >15 years, blunt trauma, and primary admission from the scene were identified. Patients were divided into two groups: Group 1—pre-massive transfusion protocol (2006–2009) and Group 2—post-massive transfusion protocol (2010–2013). Basic characteristics and intensive care unit length of stay, mortality, and fluid resuscitation data were retrieved from the registry. Standardized mortality ratio was assessed using revised injury severity classification, version II methodology. Results: Altogether, 102 patients were identified. Group 1 ( n = 56) and Group 2 ( n = 46) were comparable in their basic characteristics. The observed mortality was 35.7% and 26.1% in Groups 1 and 2, respectively. The standardized mortality ratio failed to reveal any difference between observed and expected mortality in either group. In the emergency room, the use of crystalloids decreased from 5.3 ± 3.4 to 3.3 ± 1.8 L ( p = 0.002) with increased use of fresh frozen plasma (2.9 ± 4.4 vs 5.1 ± 5.3, p = 0.007). Conclusion: No improvement in the adjusted survival of shocked pelvic fracture patients is apparent after implementation of massive transfusion protocol. Implementation of massive transfusion protocol is associated with a higher use of fresh frozen plasma and improved ratio of fresh frozen plasma:red blood cell toward the targeted 1:1 and decreased use of crystalloids.

Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014–2018)

2019 ◽  
Vol 22 (8) ◽  
pp. 696-704
Author(s):  
Elizabeth T Mansi ◽  
Jennifer E Waldrop ◽  
Elizabeth B Davidow
Keyword(s):  
Retrospective Study ◽  
Fresh Frozen Plasma ◽  
Packed Red Blood Cells ◽  
Tolerable Risk ◽  
Coagulation Testing ◽  
Before And After ◽  
Referral Hospitals ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Transfusion Reactions

Objectives The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. Methods This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. Results Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1–3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. Conclusions and relevance This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk–benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.

scholarly journals Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 983
Author(s):  
Daigo Ochiai ◽  
Yushi Abe ◽  
Rie Yamazaki ◽  
Tomoe Uemura ◽  
Ayako Toriumi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Blood Cells ◽  
Correlation Coefficients ◽  
Fresh Frozen Plasma ◽  
Blood Products ◽  
Fresh Frozen ◽  
Transfusion Protocol ◽  
Frozen Plasma

Background and objectives: Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. Materials and Methods: We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. Results: MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. Conclusions: Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage.

Management of Postpartum Hemorrhage

2018 ◽  
Author(s):  
Toni Huebscher Golen ◽  
Scott A. Shainker
Keyword(s):  
Postpartum Hemorrhage ◽  
Massive Transfusion ◽  
Placenta Accreta ◽  
Early Recognition ◽  
The United States ◽  
Morbidity And Mortality ◽  
Surgical Approaches ◽  
Clear Understanding ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

Postpartum Hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality both in the United States and world-wide.  To ensure prompt treatment, it is crucial to have a clear understanding of the causes of the PPH.  Treatment includes both medical and surgical approaches, with the necessary escalation of care with ongoing hemorrhage. Invasive placentation (placenta accreta, increta, percreta) has become a more common cause of hemorrhage related morbidity and mortality.  Patients with invasive placentation should be managed in a multidisciplinary fashion at a center familiar with this pathology and capable of managing massive hemorrhage.  Obstetrical units should have a PPH protocol as a tool to assist in early recognition and treatment.  Similarly, units should have a massive transfusion protocol at the ready for scenarios of ongoing obstetrical hemorrhage.  This review contains 5 figures, 4 tables and 65 references Keywords: Postpartum Hemorrhage, Obstetrical Hemorrhage, Uterine Atony, Uterine Inversion, Uterine Tamponade Balloon, Invasive Placentation, Placenta Accreta, Obstetric Hemorrhage Protocol, Massive Transfusion Protocol

Massive Transfusion

2018 ◽  
pp. 169-180
Author(s):  
Jay Berger
Keyword(s):  
Red Blood Cells ◽  
Blood Volume ◽  
Blood Cells ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Metabolic Complications ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Frozen Plasma

Massive transfusion is defined as transfusion of 3 units of packed red blood cells in less than 1 hour in an adult, replacement of more than 1 blood volume in 24 hours, or replacement of more than 50% of blood volume in 3 hours. Massive transfusion protocols are implemented in cases of life-threatening hemorrhage after trauma, during a surgical procedure, or during childbirth. These protocols are intended to minimize the adverse effects of hypovolemia, dilutional anemia, metabolic complications, and coagulopathy with early empiric replacement of blood products and transfusion of fresh frozen plasma, platelets, and packed red blood cells in a composition that approximates that of whole blood.

Sign in / Sign up

Export Citation Format

Share Document