Risk factors for massive transfusion in obstetrical hemorrhage and consideration of a whole blood program

John G Myers, Maxwell Braverman, Angelo Ciaraglia, Rahaf Alkhateb, Lauran Barry, Zachary Brooke, Jeffrey Chang, Hanzhang Wang, Rafael Elenes, Byron Hepburn, Kayla Ireland, Rachelle Jonas, Jeremy Nelson, Santiago Pedraza, Jun Song, Susannah Nicholson, Brian Eastridge, Ronald Stewart, Leslie Greebon, Elly M XenakisDonald Jenkins

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Postpartum hemorrhage (PPH) is one of the leading causes of obstetric complications. The goal of this study was to identify risk factors for obstetric (OB) massive transfusion (MT) and determine the feasibility of developing a low-titer group O RhD-positive whole blood (LTO + WB) protocol for OB hemorrhage. Study Design and Methods: A retrospective study of OB patients who received transfusion within 24 h. MT patients were those who received >3 U of pRBC within 1 h or > 10 U in 24 h. Patient demographics, OB history, comorbidities, blood type, antibody status, and known risk factors for PPH and maternal-fetal outcomes were compared. Logistic regression was used for univariate and multivariate analyses. Results: Of the 610 transfused OB patients, 12.0% (n = 73) required MT. Groups were well matched for body mass index (BMI), maternal comorbidities, and history of spontaneous vaginal deliveries. The incidence of the previous cesarean section was higher in the MT group. Exactly 93.9% of patients were RhD-positive and 3.77% of all patients possessed an antibody on pretransfusion testing. Patients with MT had a longer length of stay (LOS), higher rate of intensive care unit (ICU) admission, fetal death, and hysterectomy. Multivariate analysis found age >35, PPH, placenta percreta, accreta, and increta to be significant (p <.05) risk factors for MT. Discussion: Patients over 35 years and those with abnormal placentation are at increased risk of requiring MT. With a time to delivery of 2 days, potential MT patients can be identified early, and with a 94% rate of RhD-positive+, they are eligible to receive low-titer O whole blood (LTOWB) providing hemostatic resuscitation with reduced donor exposure.

Original languageEnglish (US)
Pages (from-to)S112-S119
JournalTransfusion
Volume63
Issue numberS3
DOIs
StatePublished - May 2023

Keywords

  • transfusion practices (OB GYN)
  • transfusion practices (Surgical)
  • transfusion practices (adult)

ASJC Scopus subject areas

  • Hematology
  • Immunology and Allergy
  • Immunology

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