To those of you in the US..........does anyone have a protocol for mass transfusion that specifically addresses pregnant patients or are they covered by your policy for females of childbearing age?

 

Thanks in advance for your input.

The state of Illinois mandates an OB Hemorrhage protocol.  Our hospital is still working on an actual "massive transfusion protocol".

I'm in the uk but we have cmv neg blood too

Our MTP protocol covers all patients, including OB. The OB didn't like it at first, but they couldn't find anything that it was a bad idea to use an MTP for OB patients. My thought is (scientifically unproven of course) that when any human being is hemorrhaging, they are bleeding out whole blood and probably need all products put back in.

we use same one for OB.

We had a case with RH Neg patient but she stopped bleeding before we ran out of our inventory of type specific and O neg.

I'm in Ireland and work in the National maternity hospital, we implemented a massive haemorrhage protocol in 2012. If you want any advice don't hesitate to send a PM

Best wishes

My facility is in the final stages of implementing an OB Hemorrhage Protocol, which will be different than our Massive Transfusion Protocol.  The California Maternal Quality Care Collaborative is an excellent resource for information on OB Hemorrhage.  This is a link to their website https://www.cmqcc.org/ob_hemorrhage.  Hope this helps!

I'm curious, for those of you who have a MTP specific for OB patients, how does it differ from the MTP for all other patients?  I've been through massive bleeds with OB patients as well as others and I can't think of anything I would have done different specifically for the OB patients. 

Yes, I completely agree with John, the only change I have seen is about the contact individual that makes the MTP activation is either OB physician or Perinatologist instead of a Surgeon or Intensivist. 

I'm curious, for those of you who have a MTP specific for OB patients, how does it differ from the MTP for all other patients?  I've been through massive bleeds with OB patients as well as others and I can't think of anything I would have done different specifically for the OB patients. 

Edited November 16, 201311 yr by Eagle Eye

Would be interesting to see the protocol. The differences between both 5dogs, would you share the highlights with us?

Wild guess!!!!May require Cryo earlier????

Would be interesting to see the protocol. The differences between both 5dogs, would you share the highlights with us?Wild guess!!!!May require Cryo earlier????

Our only difference is that the products are CMV neg. otherwise a ratio of blood:plasma of 1:1 with 4 units of each issued in the first instance, followed by 2 cryo and one pooled platelets. If this is all used the above is repeated until the MHP is ended

I'm curious, for those of you who have a MTP specific for OB patients, how does it differ from the MTP for all other patients? I've been through massive bleeds with OB patients as well as others and I can't think of anything I would have done different specifically for the OB patients.

Our OB Hemorrhage policy/ protocol actually came out first and is based on the CA resources mentioned. It includes immediate response from lots of folks, not just Blood Bank (anesthesia, pharmacy, rapid response team) The MT policy specifically addresses blood products and labs to draw at which time frame so the two are different.

Our OB Hemorrhage policy/ protocol actually came out first and is based on the CA resources mentioned. It includes immediate response from lots of folks, not just Blood Bank (anesthesia, pharmacy, rapid response team) The MT policy specifically addresses blood products and labs to draw at which time frame so the two are different.

 

But.......is there any difference in what the blood bank/transfusion service does? 

5dogs - Thanks for the link. Great resource.

But.......is there any difference in what the blood bank/transfusion service does?

Depending on the stage of the OB hemorrhage called, we provide the appropriate products.

Depending on the stage of the OB hemorrhage called, we provide the appropriate products.

 

I hate to sound dense but hemorrhage is hemorrhage.  Please explain what you mean by "the stage of the OB hemorrhage".   I really am trying to understand but the old brain cells don't fire as well as the used to.

There are probably some differences although they are probably case by case.  An amniotic embolism causes horrific DIC.  Trauma patients can also have DIC but maybe not so bad so quickly.  OB patients usually start with higher fibrinogen levels than other patients.  Obstetric hemorrhage can often be stopped once and for all by emergency hysterectomy whereas a massive trauma can't have everything fixed at once.  Sometimes in obstetrics you have to worry about both mom and baby.  Traumas can come in pairs too but not often with a newborn.  All those things seem like nuances that probably would not require much change to the protocol--except maybe making allowance for treating a newborn. 

Mabel, as I was walking home last night I was thinking about this and DIC did come to mind as something that is more frequent in OB bleeds than in most other massive transfusion events.  It might not be a bad idea to incorporate a DIC response into MTP specific to OB bleeds. 

 

I hate to sound dense but hemorrhage is hemorrhage. Please explain what you mean by "the stage of the OB hemorrhage". I really am trying to understand but the old brain cells don't fire as well as the used to.

Sorry if I wasn't more clear. Based on the CA program 5dogs refered to above, the OB hemorrhage is "staged" by levels. Level 1 (least serious to level 3 (most serious). OB estimates blood loss by weighing pads, etc soaked with blood as a more accurate method then by just "eyeballing it". Once a certain level is measured, the patient is "staged", BB is notified, and based on that, we provide the appropriate products.

OB organized a task force and it took about 1 year to implement. It has been very successful since.

Basically, like a MTP, if there is a protocol and everyone knows it, and it's followed, good outcomes are bound to result.

_{Our massive transfusion protocol simply says that for OB hemorrhage, Cryo and PLT use may be greater.  And we try to avoid using Rh positive units on females less than 50 years of age.}

_{And we try to avoid using Rh positive units on females less than 50 years of age.}

 

Do you mean Kell pos?