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The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: a population based study

Green, Laura, Knight, Marian, Seeney, Frances, Hopkinson, Cathy, Collins, Peter W., Collis, Rachel E., Simpson, Nigel A. B., Weeks, Andrew and Stanworth, Simon J. 2016. The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: a population based study. British Journal of Haematology 172 (4) , pp. 616-624. 10.1111/bjh.13864

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Abstract

Understanding the coagulopathy of major-obstetric-haemorrhage (MOH) that leads to massive-transfusion (MT) is fundamental to improving outcomes. This study reports on the haematological features and transfusion management of women experiencing MT [defined as transfusion of ≥8 units of red blood cells (RBC) within 24 h of delivery]. One hundred and eighty-one cases [median (interquartile range; IQR) age 33 years (29–36)] were identified from all UK hospitals, using the UK Obstetric Surveillance System between July 2012 and June 2013. The median (IQR) estimated blood loss was 6 l (4·5–8). At presentation, the median platelet count was lowest for placenta accreta, compared with other causes, while the median prothrombin time and fibrinogen were <1·5 × mean normal and <3 g/l, respectively for all aetiologies. Median platelet count and fibrinogen fell to <75 × 109/l and <2 g/l, respectively for all causes during bleeding, except for trauma. The median (IQR) units of RBC, fresh-frozen-plasma (FFP) and cryoprecipitate transfused were 10 (8–14), 6 (4–8) and 2 (2–4), respectively. The median time from the onset of bleeding to delivery of the first RBC unit was significantly shorter for women who delivered via elective caesarean section, compared with others. The coagulopathy of MT during MOH differs significantly depending on its cause, suggesting that more targeted transfusion strategies are required.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Wiley-Blackwell
ISSN: 0007-1048
Date of First Compliant Deposit: 29 June 2017
Date of Acceptance: 12 October 2015
Last Modified: 17 Jul 2017 13:31
URI: http://orca.cf.ac.uk/id/eprint/101911

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