Department of Obstetrics, Gynecology, & Reproductive Sciences, Division of Maternal Fetal Medicine, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA.
Transfusion. 2022 Mar;62(3):613-620. doi: 10.1111/trf.16794. Epub 2022 Jan 8.
To report maternal outcomes in a cohort of women who received autotransfusion of vaginally shed blood and to describe the feasibility of blood collection and cell salvage processing at the time of vaginal hemorrhage.
We conducted a retrospective case series of patients who received autotransfusion of vaginally shed blood at the time of obstetric hemorrhage from January 2014 to August 2020. Maternal data and cell salvage utilization characteristics were abstracted from the electronic medical record.
Sixty-four cases were identified in which autotransfusion of vaginally shed blood occurred during an obstetric hemorrhage. Median quantitative blood loss was 2175 ml (interquartile range 1500-2250 ml) with 89% of cases having a blood loss greater than 1000 ml. Patients on average received approximately 1.3 units of autologous blood product (384 ml, interquartile range 244-520 ml) and no direct adverse events were observed during transfusion. We observed heterogeneity in autologous blood volume across all values of quantitative blood loss. The need for allogenic blood transfusion was common and occurred in 72% of all cases (N = 46). There were no documented cases of maternal sepsis or severe infectious morbidity.
In 64 cases where autotransfusion of vaginally shed blood occurred, autotransfusion was well tolerated. Heterogeneity in autologous blood volume collection likely represents the lack of standardized protocols for blood collection in the delivery room. Autotransfusion of vaginally shed blood is a feasible and reasonable technique to employ during severe obstetric hemorrhage.
报告一组接受阴道失血自体输血的产妇结局，并描述在阴道出血时进行血液采集和细胞回收处理的可行性。
我们对 2014 年 1 月至 2020 年 8 月期间因产科出血接受阴道失血自体输血的患者进行了回顾性病例系列研究。从电子病历中提取产妇数据和细胞回收利用特征。
共确定了 64 例产科出血时发生阴道失血自体输血的病例。中位数定量失血量为 2175ml（四分位距 1500-2250ml），89%的病例失血量大于 1000ml。患者平均接受约 1.3 单位的自体血液制品（384ml，四分位距 244-520ml），输血过程中未观察到直接不良事件。我们观察到在所有定量失血量范围内自体血容量存在异质性。异体输血的需求很常见，所有病例中有 72%（N=46）需要输血。没有记录到产妇败血症或严重感染发病率的病例。
在 64 例发生阴道失血自体输血的病例中，自体输血耐受性良好。自体血容量采集的异质性可能代表分娩室缺乏标准化的血液采集协议。阴道失血自体输血是严重产科出血时采用的一种可行且合理的技术。
