Transfusion therapy optimization at an acute obstetric blood loss

Abstract

Objective. To define the role of the cryoprecipitate (CP) and prothrombin complex concentrate (PCC) in the acute obstetric blood loss treatment via the assessment of the water sectors’ state, hemostasis, and frequency and severity of clinical manifestations of the multiple organ dysfunction syndrome (MODS).
 Materials and methods. 140 women had been examined (over the years 2006-2018), whose child delivery or early postnatal period (fourth stage of labor) had got complicated by an acute severe blood loss with a circulating blood volume deficit of 40 to 60 %. Based on the intensive treatment (IT) characteristics, the patients had been divided into three groups. In the group 1 (post-hoc analysis, n=50), a normal acute blood loss intensive treatment as per the relevant clinical protocols of the Health Ministry of Ukraine had been being provided. In the group 2 (n=44), an acute blood loss intensive treatment as per the abovementioned clinical protocols of the Health Ministry of Ukraine with use of the CP as the first-line drug had been being provided. In the group 3 (n=46), the PCC (Octaplex 20 IU/kg) had been added within the treatment. Thereat, there had been assessed such criteria as follows: RBC count, Hb, Ht, prothrombin index (PI), activated partial thromboplastin time, fibrinogen; the water sectors of the human body had been assessed noninvasively, via the integral impedance method; as well as the clinical signs of the MODS.
 Results and discussion. The use of the CP as the first-line drug at a dose of 8 to 10 units had enabled to get decreased the total volume of the infusion and transfusion media by 13.7 % (p<0.05), and the total volume of the administered fresh frozen plazma (FFP) – by 12 % (p<0.05) respectively. The adding of the PCC to the relevant IT guidelines had been resulting in a reduction of the total volume of the infusion and transfusion media by 24.5 % (p<0.01), of the administered plasma volume – by 22 % (p<0.01), and of the corpuscular volume – by 9.1 % (p<0.05) respectively. Furthermore, a decrease in the vasopressor support rate (by 5.1 times, p<0.01) and in the vasopressor support duration (by 1.5 natural days, p<0.01), as well as in the adaptive lung ventilation rate and duration (by 5.7 times, p<0.01), had been being observed; thereat, the number of the patients needing the use of the diuretics had been being reduced (by 2.9 times, p<0.01), as well as the duration of their administration (by 1.7 natural days, p<0.01 respectively). The PI and fibrinogen rate had been corresponding to the norms by the end of the 1st natural day of treatment.
 Conclusions. The use of the CP as the first-line drug in the IT of an acute obstetric blood loss ensures a verifiable lessening of need for the infusion and transfusion media. The PCC as the first-line drug prevents the development and progress of the coagulopathy at the treatment of an acute obstetric blood loss, what decreases the frequency and severity of clinical manifestations of the MODS credibly.