Transfusion ratios for postpartum hemodilutional coagulopathy: An in vitro thromboelastographic model

Michaela Kristina Farber, Neeti Sadana, Richard Max Kaufman, Xiaoxia Liu, Bhavani Shankar Kodali

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective A 1:1:1 ratio of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT) has been advocated for trauma hemorrhage, but the effectiveness of this ratio for postpartum hemorrhage is unknown. We created an in vitro hemodilutional model to investigate this strategy. Study Design Blood from 20 parturients at term was diluted 50% with 0.9% normal saline. Diluted samples were reconstituted with 1:1 PRBC:FFP or 3:1 PRBC:FFP. In 10 samples, PLT were also added. Baseline, diluted, and reconstituted sample thromboelastographic values were compared. Results Maximum amplitude (MA) was lower compared to baseline values in both groups after 50% dilution with normal saline (P <.001) and remained lower than baseline despite reconstitution with 3:1:0 or 1:1:0 PRBC:FFP:PLT (P <.0001) or 3:1:1 PRBC:FFP:PLT (P <.01). MA approached baseline (P = not significant) in the samples with 1:1:1 PRBC:FFP:PLT. Conclusion The addition of PLT to 1:1 PRBC:FFP optimized MA in this in vitro hemodilutional model of postpartum hemorrhage.

Original languageEnglish (US)
Pages (from-to)323.e1-323.e7
JournalAmerican journal of obstetrics and gynecology
Issue number4
StatePublished - Apr 2014


  • dilutional coagulopathy
  • postpartum hemorrhage
  • thromboelastography
  • transfusion ratios

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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