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 ).
Symptoms of transfusion reaction.
Technical and nontechnical skills for blood transfusion.
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 | ||
| 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 | ||
| Closed-loop communication |
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