TEALE FENNING

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

Obstetric conditions associated with the need for blood transfusion may lead to morbidity and mortality if not corrected correctly.

A. How may the incidence of needing to give banked blood be reduced? (6)
B. What are the risks of transfusing banked blood products and how may they be reduced? 8
C. What blood products can be used in major obstetric haemorrhage and when is their use indicated? (6)

Nick Raine-Fenning · Posted: Tue Aug 19, 2008 3:36 pm Post subject:

Nice and not a bad 'spot' Maud. I would add a small bit on women who refuse / decline blood products as this has come up in the last 2 Confidential Enquiries although I appreciate this is detracting from the focus of your question. Might be best to ignore me and add my suggestion to a PPH or a MOH question Rolling Eyes

I'll get my coat ... Cool

Xerxes I · Posted: Sat Aug 23, 2008 1:41 pm Post subject:

Obstetric conditions associated with the need for blood transfusion may lead to morbidity and mortality if not corrected correctly.

A. How may the incidence of needing to give banked blood be reduced? (6)
Primary Prevention of anaemia in the community!
Preconception visit FBS and treat if low
In unplanned, see at booking and religiously treat
Repeat in 2 weeks and if no respond, think again, consider parenteral in the absence of haemoglobinopathies and if not compliant

Active mangement of third stage
early intervention for PPH, use of drugs early

Operations
Reduction of section rate will probably haev a beneficial effect
If expecting more than 1500 ml, consider cell salvage
Done by appropriately trained,
Improve surgical skills
In some cases, siting uterine artery probes by the radiologist may have a role to do embolisation intraoperatively

Decision in conjunction with anaesthetist
Adherence to evidence-based protocols
Audit the amount used, indications etc

B. What are the risks of transfusing banked blood products and how may they be reduced? 8
giving the wrong blood is the most common and potentially very serious
Adherence to protocols, checklists, checking and double checking by two people
Incident reporting, audit
Some suggest (do they?) deferring Tx if possible until daytime to reduce clinical mistakes

Transmission of viral infection
Addressed at national level
using sensitive testing
considering window period

Other complications, not sure but maybe hyperkalemia, pulmonary oedema, volume overload, hypothermia,

C. What blood products can be used in major obstetric haemorrhage and when is their use indicated? (6)1

Angel · Joined: 13 Jul 2008 Posts: 1 Location: London

I would add ;
Dietry advice at booking particularly for vegetarians
Check full blood count and antibody at 28 week and then 36 weeks.This is particulary important for women at risk of PPH(eg; multiparous women, H/O Previous PPH).
consider parentral iron therapy for women who are unable to take oral iron.
Autologous transfusion is not recommended in obstetric practice as women may not be able to increas their haemoglobin to original level by delivery.
Cell salvage has limited place in obstetrics due to potential risk of amniotic/fetal contaminatns and shold only be used in unit with previous experience.

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

Ok, here then finally my marking scheme:

A. How may the incidence of needing to give banked blood be reduced? (6)

Screen for anaemia at booking and in third trimester. Exclude haemoglobinopathies. If haemoglobinapathy, treat with advice from haematologist. Otherwise, oral iron preparations. Consider the use of parenteral iron iforal not tolerated, not absorbed or if no compliance. (2)

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

[quote="Xerxes I"]
giving the wrong blood is the most common and potentially very serious [quote="Xerxes I"]

I like!
Probably would have earned an extra point..