Blood Tx

Question 1

What is the proportion of maternal death, the obstetric haemorrhage is responsible for?

Answer 1

10 % of direct deaths
The 3rd leading cause of direct maternal death in UK

Question 2

Can the risk of blood transfusion be reduced?

Answer 2

By optimization of HB in the antenatal period

Question 3

What is the definition of anaemia in pregnancy?

Answer 3

first trimester haemoglobin (Hb) less than 110 g/l,
second/third
trimester Hb less than 105 g/l,
postpartum Hb less than 100 g/l,

Question 4

If normocytic or microcytic anaemia has been detected in pregnancy, what is the first step?

Answer 4

a trial of oral iron should be considered as the first step and
further tests should be undertaken if there is no demonstrable rise in Hb at 2 weeks

Question 5

When should a Pregnant woman be offered screening for anaemia ?

Answer 5

At booking
At 28 w
In twin pregnancies: at booking/ at 20-24 w / at 28 w

Question 6

When is Parenteral iron indicated for the management of antenatal anaemia?

Answer 6

1-oral iron is not tolerated or absorbed
2-patient compliance is in
doubt
3- if the woman is approaching term and there is insufficient time for oral supplementation

Question 7

What is the role of recombinant human erythropoietin (rHuEPO) for non-end-stage renal anaemia in pregnant women?

Answer 7

should only be used in the context of a controlled clinical trial
🔮 it’s used mostly in the anaemia of end stage renal disease

Question 8

When should pregnant women test their blood group & screen antibodies status?

Answer 8

All women should have their blood group and antibody status checked
at booking and at 28 w

Question 9

What is the time limit for using blood group & screen samples for provision of blood in pregnancy?

Answer 9

should be less than 3 days old.

Question 10

When to check blood group & screen In a woman at high risk of emergency transfusion, e.g. placenta praevia ?

Answer 10

should be sent once a week to exclude or
identify any new antibody formation and to keep blood available if necessary

Question 11

If there is an automated testing for blood grouping and
antibody testing , what is the need for cross matching ?

Answer 11

no cross-matching needed,
no need to reserve units for individual cases

Question 12

If secure electronic patient identification systems are not available, how to manage a first-time patient prior to transfusion ?

Answer 12

a second sample should be
requested for confirmation of the ABO group

Question 13

What is Blood product specification in pregnancy ?

Answer 13

1-ABO-, RhD- and K- (Kell-) compatible red cell units
2-unless a woman is known to be K positive, only K-negative blood should be used for transfusion in women of childbearing age
3-(CMV-) seronegative red cell and platelet components should be provided for elective transfusions
4- in emergency: standard
leucocyte-depleted components should be given to avoid delay and CMV-negative blood or
platelets are not needed for transfusion

Question 14

Is there a role for preoperative/predelivery autologous blood deposit?

Answer 14

Predelivery autologous blood deposit is not recommended.

Question 15

Is there a role for intraoperative cell salvage (IOCS)?

Answer 15

1-where the anticipated blood loss is great enough to
induce anaemia
2-or expected to exceed 20% of estimated blood volume.
🔱 should only be performed by multidisciplinary teams

Question 16

How to manage in case of IOCS during CS in RhD-negative, previously nonsensitised women & cord blood group is confirmed as RhD positive (or unknown) ?

Answer 16

minimum dose of 1500 iu
anti-D immunoglobulin should be administered following the reinfusion of salvaged red cells.
maternal blood sample should be taken for estimation of fetomaternal haemorrhage 30–40
minutes after reinfusion in case more anti-D is indicated.

Question 17

Why is anti D immunisation required after IOCS in RhD-negative women?

Answer 17

iOCS is effective at removing the common markers of amniotic fluid contamination.
it will not remove fetal blood cells

Question 18

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

Answer 18

FFP at a dose of 12–15 ml/kg should be administered for every 6 units of red cells
Subsequent FFP transfusion should be guided by the results of clotting tests
Aiming for PT / PTT < 1,5

Question 19

In what circumstances should Cryoprecipitate be used ?

Answer 19

standard dose of two 5-unit pools should be administered early in major
obstetric haemorrhage. Subsequent cryoprecipitate transfusion should be guided by fibrinogen
results, aiming to keep levels above 1.5 g/l.

Question 20

Is anti D immunization necessary if a RhD-negative woman receives RhD-positive FFP or
cryoprecipitate ?

Answer 20

should ideally be of the same group as the recipient
BUT ; No anti-D prophylaxis is required

Question 21

What is the threshold of fibrinogen associated with increased risk of PPH ?

Answer 21

< 2,9
🌸 normal ranges in pregnancy (varying between 3.5 and 6.5 g/l)

Question 22

When should platelets be used?

Answer 22

A platelet transfusion trigger of 75 x 109/l is recommended to provide a margin of safety
🔱 Aim to maintain the platelet count above 50 x 109/l

Question 23

If RhD-positive platelets are transfused to a RhD-negative woman of childbearing potential , how to manage?

Answer 23

A dose of 250 iu anti-D immunoglobulin is sufficient
❤️ This may be given subcutaneously to minimise bruising in thrombocytopenic women

Question 24

for management of major obstetric haemorrhage, Is there a role for recombinant factor VIIa (rFVIIa) therapy?

Answer 24

The use of rFVIIa may be considered as a treatment for life-threatening PPH

Question 25

What the majer side effect of recombinant factor VIIa (rFVIIa) therapy?

Answer 25

The incidence of thrombotic complications 2,5 %

Question 26

Is there a role for fibrinogen concentrate therapy in the management of major obstetric haemorrhage
?

Answer 26

Fibrinogen concentrate is NOT licensed in the UK for the management of acquired bleeding disorders.
🌸 Thus, its use in PPH should be considered only in the context of clinical trials.

Question 27

Is there a role for antifibrinolytics in the management of major obstetric haemorrhage ?

Answer 27

consideration should be given to using tranexamic acid during major obstetric haemorrhage.

Question 28

How should intrapartum anaemia be managed?

Answer 28

If the Hb is less than 70 g/l in labour or in the immediate postpartum period, the decision to transfuse should be made on individual basis

Question 29

How should women who decline blood products be managed?

Answer 29

IOCS has a role in the management of patients who refuse allogeneic blood transfusion.