TY - JOUR
T1 - Transfusion ratios for postpartum hemodilutional coagulopathy
T2 - An in vitro thromboelastographic model
AU - Farber, Michaela Kristina
AU - Sadana, Neeti
AU - Kaufman, Richard Max
AU - Liu, Xiaoxia
AU - Kodali, Bhavani Shankar
N1 - Funding Information:
This research was supported by departmental funds from the Department of Anesthesiology and Perioperative and Pain Medicine, Brigham and Women's Hospital .
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2014/4
Y1 - 2014/4
N2 - 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.
AB - 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.
KW - dilutional coagulopathy
KW - postpartum hemorrhage
KW - thromboelastography
KW - transfusion ratios
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U2 - 10.1016/j.ajog.2013.11.029
DO - 10.1016/j.ajog.2013.11.029
M3 - Article
C2 - 24269787
AN - SCOPUS:84897407614
SN - 0002-9378
VL - 210
SP - 323.e1-323.e7
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 4
ER -