Massive Blood Transfusion in the Obstetrical Patient: A Team Approach            Massive transfusion is defined as administering 10 or more units of packed red cells (PRBCs) in a 24 hour period, replacing a patient’s entire circulating volume (Malone, Hess & Fingerhut, 2006).  Patients often receive large volumes of blood products when a major hemorrhage occurs. During this emergent situation it is vital to the patient’s outcome that blood products are provided in a timely manner.            When an obstetrical hemorrhage occurs, a collaborated approach by the obstetrical team, the surgical trauma team and hematology team optimizes patient outcomes and improves blood product management. Stressful situations are best supported by standarized policies and procedures. Policies define the roles and expectations of each team member and department involved in such emergent situations. A massive transfusion policy, in a large hospital doing over 7.000 deliveries per year, was revised to include a collaborative effort to provide care for obstetrical patients experiencing such a major blood loss. Interdisciplinary resources and systems are made available for trauma and other patient populations meeting the criteria for massive transfusion. For the purpose of our policy, a massive hemorrhage was defined as a blood loss necessitating replacement of total blood volume within 6 hours.

The revisions to the policy were developed to expedite the availability of the blood products to the bedside. Standard terminology and a clear order process improved communication between the operating room and the blood bank. A massive transfusion pack (MTP) was designed to identify products needed during a massive transfusion. The use of the MTP should be considered when 6 or more units of RBCs have been transfused or the development of microvascular bleeding occurs. Role definitions were clearly identified to promote a collaborative team approach to this emergent situation. Through clear communication, the needs of the patient are quickly identified and appropriate interventions provided in an organized manner. At the same time an OB emergency hemorrhage page was developed to bring additional experts to the bedside.

The revised massive transfusion policy was implemented in 2007.  The goal of our institution is to provide timely and safe resuscitation to patients experiencing massive hemorrhage. Through a collaborative team approach, we have improved blood product management and optimized patient outcomes.