GTG 47 Blood transfusions in obstetrics

Question 1

What is anemia in first trimester defined as ?

Answer 1

Hb <110 g/L

Question 2

What Hb is anaemia in second/third trimester defined as ?

Answer 2

<105g/L

Question 3

What is anaemia defined as in postpartum?

Answer 3

Hb<100g/L

Question 4

When should women be offered screening for anaemia in pregnancy?

Answer 4

At booking and at 28/40

Question 5

When should women with multiple pregnancies be screened for anaemia?

Answer 5

Booking, 20-24 weeks, 28 weeks

Question 6

What Is the first line management for iron deficiency anaemia?

Answer 6

oral iron

Question 7

For elective transfusions in pregnancy, what type of red cell/platelet components should be provided?

Answer 7

Crossmatched, ABO-, RhD-, Kell- compatible red cell units, CMV- seronegative

Question 8

When is cell salvage recommended?

Answer 8

Cell salvage is recommended for patients where the anticipated blood loss is great enough to
induce anaemia or expected to exceed 20% of estimated blood volume.

Question 9

If cell salvage is used during C section in RhD-ve woman with cord blood group confirmed RhD + or unknown how much antiD should be administered following re-infusion of salvaged red cells?

Answer 9

1500 iu antiD immunoglobulin

Question 10

When should FFP (fresh frozen plasma) be used?

Answer 10

FFP 12-15mL/kg for every 6 units of RBC during MOH;
Subsequent FFP transfusion should be guided by Clotting tests, aiming for PT and APTT ratios <1.5x normal

Question 11

How much cryoprecipitate should be used and when?

Answer 11

2 x 5-unit pools early in MOH; subsequent transfusions should be guided by fibrinogen results, aiming to keep levels >1.5g/L

Question 12

How much anti-D prophylaxis is required if a RhD negative woman receives Rh D Positive FFP or cryo?

Answer 12

No anti-D prophylaxis required

Question 13

In an acutely bleeding patient, what should the platelet count be over?

Answer 13

aim to maintain plt count over 50 x 10^9/L

Question 14

How long does FFP take to thaw and issue?

Answer 14

at least 30 minutes

Question 15

If RhD pos platelets are transfused to a RgD negative woman of childbearing potential, does she need anti-D?

Answer 15

yes, 250 iu immunoglobulin- is sufficient to cover 5 adult therapeutic doses of platelets given within a 6- week period

Question 16

How does tranexamic acid work?

Answer 16

• anti-fibrinolytic
• synthetic derivative of amino acid lysine that REVERSIBLY binds to lysine binding sites of the plasminogen molecule, preventing activation of plasminogen to plasmin- inhibiting fibrinolysis