Obstetric Haemorrhage

Obstetric Haemorrhage

 

You are called by a colleague who is anaesthetising for a Cesarean Section. The baby has been delivered, as has been the placenta.

The obstetrician is having trouble controlling the blood loss. You walk in to the operating theatre and it is obvious there is a large amount of blood loss.

He wants you to organize some blood products, someone has whipped off some coags. The results have just come back. This is what you’ve got……

HB = 62, Platelets = 80, INR = 1.9, Fibrinogen = 0.6

 

This patient is anaemic.

 

On the basis of those blood results what are you going to order.

I would order cryoprecipitate to increase the fibrinogen to over 1.

 

How much cryoprecipitate would you ask for.

Cryo dose is 10mls per kilo, let’s say she was 70 kilos. I can’t remember the units or how it comes.

 

That is alright.

I would give her packed cells. I would like 5 units of packed cells, I would like to have 4 units of fresh frozen plasma and I’d like a bag which is 5 units of platelets.

 

Just as you walk in the nurse says by the way there was a transfusion reaction previously. On the history there is a big red sticker which says transfusion reaction previously.

I would like to know what the transfusion reaction was as she may have been given the wrong blood.

 

No it wasn’t that. It was ill defined for whatever reason.

It means she should have properly cross-matched blood. 

 

Which she would have had done for a Cesarean Section anyway.  

OK, you can be ready for the transfusion reaction which would include having vasopressors and adrenaline ready. The only thing you might do would be to give a dose of steroids and run the platelets through a white cell filter.

 

In general terms what are transfusion reactions usually due to?

It can be due to ABO incompatibility

 

Pretty unusual.

They may be due to antibody reactions.

 

Antibodies, which are where?

Antibodies which are in the plasma. The products which have antibodies like fresh frozen plasma and cryoprecipitate are the ones that tend to cause the reactions.

 

Apart from blood products what else might you consider using in this woman, she’s bleeding a lot, you’ve got your blood running, you’ve got your other products going, is there anything else you would consider using?

The other thing you can use is recombinant factor 7.  

 

When would you use that?  

It would depend. If there is ongoing loss despite surgical correction with a relatively normal pH, normal temperature and appropriate other factors have been given, you can consider factor 7

 

Time.