The rational use of blood and its components in obstetrical and gynecological bleeding complications

Introduction Hemorrhagic complications in obstetrical practice are frequently encountered that require specific blood component therapy. This chapter presents an overview of the rational use of blood components in pregnancy, for obstetrical bleeding complications, and in general gynecology practice. Section I discusses blood collection, transfusion risk, and pretransfusion compatibility testing. Section II describes the preparation, contents, storage, and indications for blood and its components. Section III focuses on the use of new pharmacological therapeutic agents in lieu of blood and component therapy in specific patient populations. Section IV reviews transfusion of blood components in clinical situations involving the obstetrical patient. Blood collection, transfusion risk, and pretransfusion testing Blood collection Each year in the United States over 12 million units of whole blood are collected. Blood donors are qualified for donation based on an initial history and physical examination using eligibility criteria established by the Food and Drug Administration (FDA). Blood donation is performed using two different methods: (1) whole blood donation where a single unit of whole blood (WB) is collected into a plastic bag and then separated at a later time into components, or (2) apheresis donation via an automated technology where the donor is connected to an instrument which selectively collects either red blood cells (RBCs), platelets or plasma. The blood components are RBCs, plasma, cryoprecipitate, and platelets. The donor is tested for infectious diseases (see Table 17.1), ABO blood group, Rh(D) type, and red cell alloantibodies.