Retrospective study to investigate fresh frozen plasma and packed cell ratios when administered for women with postpartum hemorrhage, before and after introduction of a massive transfusion protocol

•Obstetric massive transfusion protocols (MTP) suggest fixed 1:1 blood product ratios.•We compared transfusion practice before and after protocol introduction.•Blood product transfusion ratios were similar before and after introduction.•As more packed red blood cells were administered, transfusion r...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2018-11, Vol.36, p.34-41
Main Authors: Weiniger, C.F., Yakirevich-Amir, N., Sela, H.Y., Gural, A., Ioscovich, A., Einav, S.
Format: Article
Language:English
Subjects:
Adult
Blood Transfusion - methods
Cohort Studies
Erythrocyte Transfusion - methods
Female
Fixed ratio
Fresh frozen plasma
Humans
Obstetrics
Plasma
Postpartum hemorrhage
Postpartum Hemorrhage - therapy
Practice Guidelines as Topic
Pregnancy
Retrospective Studies
Transfusion protocol
Treatment Outcome
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Summary:•Obstetric massive transfusion protocols (MTP) suggest fixed 1:1 blood product ratios.•We compared transfusion practice before and after protocol introduction.•Blood product transfusion ratios were similar before and after introduction.•As more packed red blood cells were administered, transfusion ratios reached 1:1.•Factors other than MTP may influence the blood product transfusion ratios. Administration of packed red blood cells (PRBC) and fresh frozen plasma (FFP) to women with postpartum hemorrhage (PPH) before and after introduction of a massive transfusion protocol. The retrospective PPH study cohort of two tertiary centers was identified using blood bank records, verified by patient electronic medical records. We identified women transfused with ≥3 units PRBC in a short time period within 24 hours of delivery. Since 2010, both centers have used a protocol using 1:1 FFP:PRBC ratios. Demographic, obstetric, and blood management data were retrieved from medical records. Outcome measures included estimated blood loss, blood product administration, and hematologic variables. 273 women were included, 112 (41.0%) prior to introduction of the protocol (2004–2009) and 161 (59.0%) afterwards (2010–2014). The frequency of women managed with 1:1 FFP:PRBC ratios was similar before 55/112 (49.1%) and after 83/161 (51.6%) introduction of the protocol (P=0.69). There was strong correlation between PRBC units transfused and the FFP:PRBC transfusion ratio (R-square 0.866, P 
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2018.08.001