Depatment of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Depatment of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.
Am J Perinatol. 2023 Jan;40(1):95-98. doi: 10.1055/s-0041-1728833. Epub 2021 May 14.
Massive transfusion protocols are widely implemented in obstetrical practice in case of severe hemorrhage; however, different recommendations exist regarding the appropriate ratios of blood product components to be transfused. We report our extensive experience with massive component transfusion in a referral center in which the standard massive transfusion protocol is modified by ongoing clinical and laboratory evaluation.
A retrospective chart review of all patients who had massive transfusion protocol activation in a level 4 referral center for obstetrical practice was performed from January 2014 to January 2020. Data collected included the etiology of obstetrical hemorrhage, number of blood products of each type transfused, crystalloid infusion, and several indices of maternal morbidity and mortality. Data are presented with descriptive statistics.
A total of 62 patients had massive transfusion protocol activation, of which 97% received blood products. Uterine atony was found to be the most common etiology for massive hemorrhage (34%), followed by placenta accreta spectrum (32%). The mean estimated blood loss was 1,945 mL. A mean of 6.5 units of packed red blood cells, 14.8 units of fresh frozen plasma and cryoprecipitate, and 8.3 units of platelets were transfused per patient. No maternal deaths were seen.
The ratios of transfused packed red blood cell to fresh frozen plasma/cryoprecipitate and of packed red blood cell to platelet units varied significantly from the fixed initial infusion ratio called for by our massive transfusion protocol resulting in universally favorable maternal outcomes. When rapid laboratory evaluation of hematologic and clotting parameters is available, careful use of this information may facilitate safe modification of an initial fixed transfusion ratio based on etiology of the hemorrhage and individual patient response.
· Massive transfusion protocols in obstetrics follow fixed ratios of blood products.. · Actual usage of blood components is different than the standardized protocols.. · We recommend to modify the initial fixed transfusion ratio according to clinical response..
在严重出血的情况下，产科实践中广泛实施大量输血方案；然而，对于要输注的血液制品成分的适当比例存在不同的建议。我们报告了在转诊中心使用大量成分输血的广泛经验，该中心通过持续的临床和实验室评估来修改标准大量输血方案。
对 2014 年 1 月至 2020 年 1 月期间，在产科实践的 4 级转诊中心激活大量输血方案的所有患者进行了回顾性图表审查。收集的数据包括产科出血的病因、每种类型的血液制品输注数量、晶体液输注以及产妇发病率和死亡率的几个指标。数据以描述性统计呈现。
共有 62 名患者激活了大量输血方案，其中 97%的患者接受了血液制品。发现子宫收缩乏力是大出血的最常见病因（34%），其次是胎盘植入谱系疾病（32%）。平均估计失血量为 1945 毫升。每位患者平均输注 6.5 单位浓缩红细胞、14.8 单位新鲜冷冻血浆和冷沉淀、8.3 单位血小板。未见产妇死亡。
输注的浓缩红细胞与新鲜冷冻血浆/冷沉淀的比例以及浓缩红细胞与血小板单位的比例与我们的大量输血方案规定的初始固定输注比例有显著差异，导致普遍有利的产妇结局。当可以快速评估血液学和凝血参数时，根据出血病因和个体患者反应，谨慎使用这些信息可以有助于安全修改初始固定输血比例。
· 产科大量输血方案遵循血液制品的固定比例。· 实际使用的血液成分与标准化方案不同。· 我们建议根据临床反应修改初始固定输血比例。
