Myers et al reported a whole blood program for massive transfusion in obstetrical hemorrhage. The authors are from the University of Texas at San Antonio.
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Massive Transfusion Time Frame
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Packed RBC Transfused
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1 hour
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> 3 units
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24 hours
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> 10 units
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An obstetrical patient at increased risk for massive hemorrhage is identified based on:
(1) age > 35 years
(2) abnormal placentation (placenta percreta, accreta, increta)
Additional factors associated with massive transfusion:
(1) postpartum hemorrhage
(2) history of previous cesarean section
Frequency D-positive: 94%
Frequency of antibodies on pretransfusion testing: 3.8%
The protocol consists of:
(1) identifying high risk patients early
(2) performing pretransfusion testing, if possible, prior to delivery
(3) use of low-titer type O whole blood (LTOWB) if massive hemorrhage occurs and typed blood is not available
