Whole Blood in the Management of Hypovolemia Due to Obstetric Hemorrhage

Alexander, James M. MD; Sarode, Ravindra MD; McIntire, Donald D. PhD; Burner, James D. MD; Leveno, Kenneth J. MD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181a4b390
Original Research
Abstract

OBJECTIVE: To study the use of blood products including whole blood, for the management of obstetric hemorrhage requiring transfusion.

METHODS: This was a population-based, observational study of all women receiving blood for hypovolemia because of hemorrhage at the Parkland obstetrics service between March 24, 2002, and June 12, 2006. Hypovolemia was diagnosed in women who sustained hemorrhages sufficient enough to provoke hemodynamic instability.

RESULTS: A total of 66,369 women gave birth during the study period, and 1,540 (2.3%) received a blood transfusion. Six hundred fifty-nine (43%) received only whole blood, 593 (39%) received only packed red blood cells, and 288 (19%) received combinations of blood products, including thawed plasma, platelets, and cryoprecipitate. The number of units transfused was similar in the whole blood and packed red blood cell groups (mean 2 units) and higher in the combination group (mean 5.5 units). Complications attributable to hypovolemia were similar in frequency in the whole blood and packed red blood cells groups, including intensive care unit admission (1%), hypofibrinogenemia (0.3%), and adult respiratory syndrome (0.5% compared with .3%). Acute tubular necrosis was more common in the packed red blood cell group (2% compared with 0.3%, P<.001). All of these outcomes were increased in the combination transfusion group. There were three maternal deaths in the cohort, two in the combination group and one in the packed red blood cells group.

CONCLUSION: The risk of acute tubular necrosis is significantly reduced in women receiving whole blood transfusion for hypovolemia due to obstetric hemorrhage.

LEVEL OF EVIDENCE: III

In Brief

Acute tubular necrosis is significantly decreased in women receiving whole blood transfusion for hypovolemia.

Author Information

From the Departments of Obstetrics and Gynecology and Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.

Corresponding author: James M. Alexander, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9032; e-mail: james.alexander@utsouthwestern.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists.