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Mass Transfusion Protocol for Pregnant Patients

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No, I really meant Rh-positive.  Our Massive Transfusion Protocol (greater than 4 units per hour with continued bleeding), calls for switching to Rh positive blood on all males and females greater than 50 yoa.

We will also switch Rh negative females of childbearing age if needed.  We are 2+ hours from our supplier and can't afford to use all our O negs on one patient.  We have never had to do this, but we will if we need to.



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My hospital helped develop an Massive Obstetrical Hemmorhage Protocol that has garnered recognition for our multidisciplinary team.  This is an email that I sent out to my staff to help understand what is going on. 



There are risk levels and stage levels. 


A risk level is “how likely is the woman to have a hemorrhage”. Therefore, we draw and test initially based on a risk level.

Low Risk = Band and Hold

Medium Risk = Type and Screen

High Risk = Type and Cross 2 units


Stage levels coincide with “how is the patient doing”

                Stage 0 = Routine delivery

                Stage 1 = Increased bleeding but still watch and see

                Stage 2 = Increasing bleeding. Maternal Hemorrhage called. DIC panels every 30 minutes initiated.  Products are NOT ordered at this stage.

Stage 3 = Blood loss is >1500mL. DIC panels every 30 minutes.  Need MOH Pack (3 RBC, 2 Plasma, 1 PLP, 1 cryo), additional packs as needed.

                Stage 4 = Modified post-partum care based  on what stage 2 or 3 hemorrhage.


Patients may go through the levels quickly but remember that the physicians are trying all options to stop the hemorrhaging. Therefore patients may never go to stage 3 but stop at stage 2. And not need any blood products.


We have found over the last 3 years that they will typically transfuse everything but the cryo so we have changed the policy to not give the cryo until specifically requested (which is usually with fibrinogen <200)

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