patient blood management

[tkakin]

I was recently asked how to manage a patient who is pregnant.  I was told the patient is older and has had complications of which I was not told.  The patient is not wanting to be transfused if PPH occurs.  I can only think of TXA and Cell salvage for this patient to avoid blood transfusion during PPH.  Do you have any other ideas?  I did recommend VERY STRONGLY that they discuss their concerns with their physician!

Thanks

Teresa

[Malcolm Needs ☆]

Just off the top of my head, I can't think of much more, except for the obstetricians to make sure that any preexisting anaemia is corrected by iron therapy, or vitamin B12 and folate or, in extremis, erythropoietin, so that, if there is any blood lose, the Hb and Hct are as high as possible prior to the haemorrhage (without, of course, making her polycythemic!).

[Neil Blumberg]

Two other approaches that should be considered, likely employed are (1) minimizing blood draws and minimizing volume of any blood draws and (2) consideration to prophylactic use of EPO and/or intravenous iron.  Both have been shown to help maintain hemoglobin/hematocrit levels in bleeding patients.