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

Am J Obstet Gynecol. 2014 Apr;210(4):323.e1-323.e7. doi: 10.1016/j.ajog.2013.11.029. Epub 2013 Nov 19.

Abstract

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.

Keywords: dilutional coagulopathy; postpartum hemorrhage; thromboelastography; transfusion ratios.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blood Transfusion / methods*
  • Erythrocyte Count
  • Female
  • Hemodilution
  • Humans
  • In Vitro Techniques
  • Models, Biological*
  • Platelet Count
  • Postpartum Hemorrhage / blood*
  • Postpartum Hemorrhage / therapy*
  • Pregnancy
  • Thrombelastography
  • Young Adult