Blood Transfusion in Obstetrics - GT47 Flashcards
Where does haemorrhage rank in causes of maternal death and what % of direct deaths in the UK?
3rd direct (8th overall) 10% direct deaths
How many cases of severe haemorrhage are there each year in the UK?
Approx 4000
What are the Hb cut offs to diagnose anaemia in pregnancy?
<110 in T1
<105 in T2/3
<100 postnatal
When should Hb be tested in pregnancy?
Booking
28/40
20-24 weeks also if multiple gestation
What is the time limit for Group and Save when blood required?
3/7
How often should Group and Save be taken inthose at high risk of bleeding (e.g. placenta praevia) with no alloantibodies?
weekly
When is intraoperative cell salvage recommended?
When anticipated EBL would be enough to induce anaemia/exceeds 20% total blood volume
What are the considerations for blood transfusions in pregnancy?
ABO Rh Kell Matched And if during pregnancy for CMV neg blood and platelets
How much Anti D should be given to Rh neg women when cell salvage is used?
If cord blood confirmed as Rh+ or unknown
Give min. 1500IU following reinfusion
Take Kleihauer 30-40mins after reinfusion in case more needed
At what Hb levels is blood transfusion required?
Almost always <60g/dL
Rarely >100g/dL
When should FFP be given and how much?
12-15ml/kg for every 6 units of red cells
Maintain PT and APTT ratios at <1.5x normal
Ideally same group, antiD not required
When should cryoprecipitate be given and how much?
Two 5-unit pools early in major haemorrhage
Aim fibrinogen >1.5g/L
Ideally same group, antiD not required
When should platelets be given?
Maintain >50 in acutely bleeding pt
Ideally trigger <75 for safety margin
Ideally ABO and Rh matched
How much antiD should be given if Rh+ platelets given to Rh- woman?
250IU enough to cover 5 therapeutic doses over a 6 week period
How should platelets be transfused?
Unsused blood giving set - not one previously used for red cells
