Blood transfusion in obstetrics GTG

Question 1

How can the risk of blood transfusion be reduced?

Answer 1

• Optimise antenatal Hb
• Active management of the third stage
• Women at high risk of haemorrhage should be advised to deliver in hospital.
• If high risk of haemorrhage consider using cell salvage

Question 2

Definition of anaemia in pregnancy?

Answer 2

1st trimester: <110

2nd and 3rd trimester: <105

Postpartum: <100

Question 3

Initial management of anaemia in pregnancy

Answer 3

Start oral iron and reassess Hb in 2/52

Check compliance

Question 4

When should FBC be taken?

Answer 4

Booking and 28/40

Additional test at 20-24/40 in multiple pregnancies

Question 5

Indication of parenteral iron?

Answer 5

When oral iron is not tolerated or absorbed

Patient compliance is in doubt

If the woman is approaching term and there is insufficient time for oral supplementation to be effective.

Question 6

If blood transfusion is required during pregnancy what else should blood be screened for?

Answer 6

CMV

Antenatal blood transfusions should be CMV -ve to avoid risk of infection of fetus

Question 7

In what circumstances should fresh frozen plasma (FFP) be used?

Answer 7

• For every 6 units of blood

- To maintain APTT/PT <1.5 times normal

Question 8

In what circumstances should cryoprecipitate be used?

Answer 8

Guided by fibrinogen levels - aim to keep >1.5

Question 9

When should platelets be used?

Answer 9

To keep plt >50, start transfusing once plt <75