A retrospective analysis of transfusion management for obstetric hemorrhage in a Japanese obstetric center

Abstract

Background. Since cryoprecipitate, fibrinogen concentrate, or recombinant activated factor VII is not approved by public medical insurance in Japan, we retrospectively assessed blood product usage in patients with obstetric hemorrhage at our tertiary obstetric center. Material and Methods. 220 patients with obstetric hemorrhagic disorders who underwent blood product transfusion in our institution during a 5-year period were reviewed for the types and volumes of blood products transfused. Results. There was a significant positive correlation (P< 0.001) between the volume of RCC (red blood cell concentrate) transfused and that of FFP (fresh frozen plasma), irrespective of underlying obstetric disorders. The median of FFP to RCC ratio in each patient was 1.3-1.4, when 6 or more units of RCC were transfused. Conclusions. In transfusion for massive obstetric hemorrhage in terms of appropriate supplementation of coagulation factors, the transfusion of RCC : FFP = 1 : 1.3-1.4 may be desirable.

Figure 1

Correlation between the volume of RCC and FFP in obstetric hemorrhage patients with allogenic transfusion (n = 196). A significant positive correlation was observed between the volume of RCC and that of FFP, as also shown in Table 5. Patients who underwent autologous transfusion were excluded. An outlier with amniotic fluid embolism who had 50 units of RCC and 116 units of FFP was also excluded.

Figure 2

Hemoglobin (Hb) concentration, percent prothrombin activity (%PT), activated partial thromboplastin time (aPTT), and fibrinogen concentration immediately before blood transfusion in each obstetric hemorrhagic disorder (n = 211). Box plot graphs represent the median value as well as the upper and lower quartiles. The line across the middle of the box identifies the median sample value. The whiskers extend from the ends of the box to the outermost data point. The thick lines denote the mean values. Different superscript letters (a, b, c) denote significant difference at P < 0.05. Patients were excluded as mentioned in the text.

Figure 3

Correlation between the volume of RCC transfused and Hb concentration or %PT in obstetric hemorrhage patients (n = 187). A significant negative correlation was observed between the volume of RCC transfused and Hb (a), or RCC and %PT (b). Patients were excluded as mentioned in the text.

Figure 4

Correlation between the volume of FFP transfused and %PT or fibrinogen concentration in obstetric hemorrhage patients (n = 187). A significant negative correlation was observed between the volume of FFP transfused and %PT (a), or FFP and fibrinogen (b). Patients were excluded as mentioned in the text.