BLOOD TRANSFUSION IN OBSTETRICS

AND GYNAECOLOGY
• INTRODUCTION
• CLASSIFICATION OF BLOOD AND BLOOD PRODUCTS
• INDICATIONS FOR BLOOD TRANSFUSION
• PROCEDURE FOR BLOOD TRANSFUSION
• COMPLICATIONS OF BLOOD TRANSFUSION
• CONCLUSION
INTRODUCTION
• Blood transfusion, though life saving when properly applied is a high
risk procedure that could result in significant morbidity and mortality.
Hence caution need to be exercised both in decision to transfuse a
patient and the process of administration. The decision therefore
need to be individualized and should involve input from the most
experience member of the obstetrics and gynaecological team
CLASSIFICATIONS OF BLOOD AND
BLOOD PRODUCTS
• Blood and blood products are broadly classified as follows
• BOOD
Whole blood
Sedimented cells
BLOOD PRODUCTS
a)Blood component
 Packed cells
 Platelet concentrate
 Fresh frozen plasma
 Cryoprecipitate
b)Plasma derivatives
• Albumin
• Coagulation factors
• immunoglobulins
• Blood transfusion means giving blood or blood component from one
person (donor) to another person (recipient).It is usually done to
replace blood which have been lost either due to sever bleeding
following obstetric hemorrhage or during major gynaecological
surgeries with significant blood loss.
• Blood can be transfused as whole blood or sedimented cells .Whole
blood contains all the component of blood; cells and plasma.
Sedimented blood on the other hand are obtained when blood is
allowed to hang in gravity undisturbed. Only the sedimented
components are transfused leaving off the plasma
• The concept of safe transfusion should be adhered to anytime blood
transfusion is being contemplated. It involves ensuring the right blood
is given to the right patient, at the right time and place. This supposes
that health care professionals involve must have cross-checked all of
the above before commencement of transfusion.
• Whole blood :This is blood product that contains all the components
of blood. It is said to be fresh if used less than 8 hours following
donation. It contains red blood cells, white blood cells, platelets and
plasma with clotting factors
• A bag of whole blood is about 550mls in volume and should raise the
haemoglobin by 1g/dl and haematocrit by 3%.It is stored in citrate
phosphate dextrose adenine anti coagulated bag at temperature of 2-
6 degree celcius for up to 35 days from the date of donation. The bag
usually indicate the number, information on blood group of donor,
screening result, date of donation and expiration.
INDICATIONS FOR BLOOD
TRANSFUSION
• Severe anaemia in pregnancy at any gestational age and from any
cause
• Moderate anaemia close to expected date of delivery
• Sickle cell crisis in pregnancy
• Anaemic heart failure in pregnancy
• Acute severe blood loss occurring antepartum, intra partum or post
partum
• Severe blood loss during major gynaecological surgeries
• Anaemia due to malignant diseases.
PROCEDURE FOR BLOOD
TRANSFUSION
• The patient is counseled on the procedure ,its benefit and possible
complications
• Samples are then drawn for screening, grouping and cross-matching
• Donor’s blood is then collected and transferred with appropriate labelling
for use
• The patient should have an appropriate size cannula inserted depending on
the indication and clinical scenario
• Before commencement of transfusion, the blood is cross checked to ensure
all the rules of safe transfusion are followed, the disease condition screen
for as well as their results must be known and the expiry date of the blood
noted.
• The blood transfusion order is written, including the pre and post
transfusion vital signs, the rate of flow of the blood ,duration of flow
and what should be done in case of transfusion reaction
• The blood is then set up using blood giving set, usually for 4-6 hours
or quicker depending on the clinical scenario. The first 15 minutes
should be observed for reaction
• In the event of reaction, the transfusion should be discontinued and
drugs administered which may include antihistamines and
steroids.The blood should then be returned to the laboratory for
regrouping and cross-matching.
TYPES OF BLOOD TRANSFUSION
• HOMOLOGOUS BLOOD
This is blood or blood component, from another human donor taken
and stored for later transfusion as required.
AUTOLOGOUS BLOOD
This entails the collection and subsequent transfusion of the patient
own blood or blood products, the advantage of this is that it eliminates
the risk of immunological and disease transmission complications. And
may be the only readily available source blood for transfusion
TYPES OF AUTOLOGOUS BLOOD
TRANSFUSION
Preoperative blood donation

Acute normovolaemic haemodilution

Blood salvage
• In preoperative donation, patient donate a unit of blood at intervals
of not less than five days in the preoperative period. The usual
testing, storage and labelling for homologous blood is done. Oral
haematinics is prescribed for the patient.
• In acute normovolaemic haemodilution a predetermined volume of
the patient blood is collected and it is simultaneously replaced with
crystalloid or colloid to maintain blood volume. The result of this, is
that during surgery, the patient loses fewer red blood cells due to
(haemodilution) for a given blood loss and the autologous blood can
be reinfused, the advantage is that the clotting elements and platelet
is intact(crystalloid 3:1;colloid1:1
• Blood salvage; This involves the collection of shed blood from wound,
body cavities and joint spaces and its subsequent re infusion into the
same patient. The commonest application of blood salvage in
obstetrics and gynaecology is during laparotomy for ruptured ectopic
pregnancy
Blood salvage is contraindicated when the blood is contaminated with
Bowel content, bacteria, fat, amniotic fluid, urine, malignant cells, and
when the blood has been shed for more than 6 hours (haemolysis of
red blood cells)
• Methods of blood salvage;
Guaze filtration
Simple suction collection system
Automated suction collection system
• Gauze filtration involves blood collected from body cavity under
aseptic condition, using a small bowl. The salvage blood is mixed with
an anticoagulant, filtered through layers of gauze and re infused to
the patient. It is cheap and use in cases of ruptured ectopic
pregnancy management.
• Manual suction collection system, involves use of suction system that
incorporate suction tubes which are connected to the storage bottle
that contains anticoagulant. During surgery blood is sucked from body
cavity to the bottle. It is important to keep the suction pressure low to
prevent haemolysis of red blood cells.
• Automated suction collection system, involves use of automated
equipment which collects, anti coagulates, wash and re-suspends red
blood cell in crystalloid fluid before re infusion. This equipment is
expensive and not readily available in developing countries
COMPLICATIONS OF BLOOD
TRANSFUSION
• Transfusion related complications could be classified into acute or
delayed with further division into infectious and non infectious type
The infectious types are now rare due to advances in blood screening
process
• Non-infectious complications; These could be acute or delayed. Acute
are those occurring in the first 24 hours while delayed occur after 24
hours. Acute non-infection complication include; acute haemolytic
reaction, allergic reaction, anaphylactic reaction, coagulation problem
in massive transfusion, febrile reaction, septic or bacterial
contamination and acute circulatory overload.
• Delayed reaction include graft versus host reaction, post transfusion
purpura among others.
INFECTIOUS COMPLICATIONS; Transmission of hepatitis B and C, HIV,
Syphilis, human herpes virus
Massive blood transfusion; This is defined as replacement of one blood
volume in 24 hours or greater than 50% of blood volume in 4hours. It
can occur in setting of obstetrics haemorrhage
CONCLUSION
• Blood and blood products use are a component of comprehensive
essential and emergency obstetrics care. Their role cannot be
overemphasized in combating conditions which are leading causes of
maternal mortality. Efforts need to be put in place to ensure
availability of blood and blood products and improved efficiency of
blood banking system in our health facilities. This would go along way
in reducing maternal morbidity and mortality.