Postpartum hemorrhage: Blood product management and massive transfusion

In comparative effectiveness studies of multicomponent, sequential interventions like blood product transfusion (plasma, platelets, red blood cells) for trauma and critical care patients, the timing and dynamics of treatment relative to the fragility of a patient’s condition is often overlooked and underappreciated. While many hospitals have established massive transfusion protocols to ensure that physiologically optimal combinations of blood products are rapidly available, the period of time required to achieve a specified massive transfusion standard (e.g. a 1:1 or 1:2 ratio of plasma or platelets:red blood cells) has been ignored. To account for the time-varying characteristics of transfusions, we use semiparametric rate models for multivariate recurrent events to estimate blood product ratios. We use latent variables to account for multiple sources of informative censoring (early surgical or endovascular hemorrhage control procedures or death). The major advantage is that the distributions of latent variables and the dependence structure between the multivariate recurrent events and informative censoring need not be specified. Thus, our approach is robust to complex model assumptions. We establish asymptotic properties and evaluate finite sample performance through simulations, and apply the method to data from the PRospective Observational Multicenter Major Trauma Transfusion study.

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Management of Postpartum Hemorrhage

10.2310/obg.19029 ◽

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

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Women Receiving Massive Transfusion Due to Postpartum Hemorrhage

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000661340.97850.4e ◽

2020 ◽

Vol 40 (2) ◽

pp. 67-68

Author(s):

P.I. Ramler ◽

T. van den Akker ◽

D.D.C.A. Henriquez ◽

J.J. Zwart ◽

J. van Roosmalen ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Massive Transfusion

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Fluid, Electrolyte, Blood, and Blood Product Management

Critical Care ◽

10.1016/b978-0-323-02262-0.50010-5 ◽

2005 ◽

pp. 59-72

Author(s):

James E. Szalados

Keyword(s):

Blood Product ◽

Product Management

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An evaluation of blood product utilization rates with massive transfusion protocol: Before and after thromboelastography (TEG) use in trauma

The American Journal of Surgery ◽

10.1016/j.amjsurg.2019.08.027 ◽

2019 ◽

Vol 218 (6) ◽

pp. 1175-1180 ◽

Cited By ~ 6

Author(s):

Mitchell Unruh ◽

Jared Reyes ◽

Stephen D. Helmer ◽

James M. Haan

Keyword(s):

Blood Product ◽

Massive Transfusion ◽

Massive Transfusion Protocol ◽

Before And After ◽

Transfusion Protocol

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Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol

The American Surgeon ◽

10.1177/000313482008600120 ◽

2020 ◽

Vol 86 (1) ◽

pp. 35-41

Author(s):

L. Andrew May ◽

Kevin N. Harrell ◽

Christopher M. Bell ◽

Angela Basham-Saif ◽

Donald E. Barker ◽

...

Keyword(s):

Blood Product ◽

Trauma Registry ◽

Massive Transfusion ◽

Blood Products ◽

Packed Red Blood Cells ◽

Massive Blood Loss ◽

Massive Transfusion Protocol ◽

Nurse Clinicians ◽

Level I ◽

Transfusion Protocol

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007–2015) or TNCs (2015–2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

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