Massive transfusion drains blood supply

Transfusion medicine

20 Oct 2015

A Victorian patient needed the equivalent of the entire state’s daily use of blood products during ten hours of surgery, delegates at HAA2015 here in Adelaide were told.

Nicole vander Linden, from the Royal Children’s Hospital in Melbourne, said a pregnant woman was found to have significant placenta accreta – an abnormal adherent placenta that had infiltrated directly into the myometrium and also the bladder.

A Caesarean was started, with six units of red cells, fresh frozen plasma and platelets available in the blood bank.

“Surgery was complicated by significant blood loss and coagulopathy and required the transfusion of multiple blood products,” Ms vander Linden said.

“Rapid, major blood loss occurred on a number of occasions and challenged our local resources, so contingency plans were implemented to support this level of transfusion.”

The procedure involved three anaesthetists, a gynaecological oncologist, two obstetricians, a urologist, a vascular surgeon, a paediatrician, a radiologist, two haematologists, six registrars, six anaesthetics nurses (four checking blood products and two running rapid infusers), a midwife and two scientific staff in the blood bank.

More than 300 units of blood products were used including 108 packs of red cells, 14 units of platelets, 60 units of fresh frozen plasma and 128 units of cryoprecipitate, at a cost of almost $90,000.

Cell salvage collected 34 litres from the surgical field and re-transfused 12 litres of red cells. The estimated blood loss was more than 20 litres.

“The patient survived and went home to her new baby and three other children,” Ms vander Linden said.

“Massive transfusion is a not infrequent occurrence in tertiary obstetric care, defined as the transfusion of five units or more of red cells in less than four hours.

“A hospital guideline directs management of women with this disorder and requires multidisciplinary management including the relevant surgical, anaesthetic, nursing and laboratory supports.”

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