Blood Transfusion

Learning Objectives

•
Identify the contents and indications for various blood component therapies.
•
Recognize and manage transfusion reactions.

In the event of a hemorrhage, blood transfusion can be lifesaving. The obstetric team must be well-versed in when to transfuse which products as well as how to respond to transfusion reactions ( Fig. 18.1 ).

Blood Components

Tables 18.1 shows the components of blood products and the expected clinical response to each product.

Table 18.1

Blood Components

Blood Product	Contents	Volume	Expected Effect
Packed red blood cells (RBCs)	Red blood cells	250–350 mL	Raise hemoglobin by 1 g/dL
Platelets (given as “superpack” of 6 units)	Platelets	250–300 mL	Raise platelets by 30,000/mm ³
Fresh frozen plasma (FFP)	All clotting factors	200–300 mL	Raise fibrinogen by 8–10 mg/dL
Cryoprecipitate (given as pool of five bags)	Fibrinogen, vWF, factor VIII, factor XIII	100 mL	Raise fibrinogen by 50 mg/dL

Simulation Checklist

		Time	Comments
Initial response	Recognized transfusion reaction
	Stopped blood transfusion
	Notified physician
Airway	Checked for airway compromise, anaphylaxis
Breathing	Checked breathing
Circulation	Maintained patency of IV with normal saline
Circulation	Took blood pressure
Interventions	Checked urine for hematuria
	Sent sample of patient’s blood to blood bank
	Bolused normal saline
Documentation	Timing of events
	Notification of blood bank
	Persons present
Communication	Directed communication
Communication	Closed-loop communication