Usage of blood components in obstetric practice

Abstract

Transfusion of blood and its components form an important component in obstetric care. Almost 5% of pregnant mothers require some sort of red cell and/or component transfusion as part of their obstetric management. Although red cell usage in large parts of developed countries are coming down, its usage in obstetric care is increasing. About 27% of maternal deaths in the world are due to hemorrhage. There are many causes where transfusion with different blood components is required in obstetric practice; to name a few are – accidental hemorrhage, placenta previa, hemoglobinopathies, pre-eclamptic toxemia, postpartum hemorrhage, amniotic fluid embolism, disseminated intravascular coagulation, malaria, etc. Certain complications and challenges of transfusion such as transfusion related acute lung injury, microangiopathy, Thrombotic thrombocytopenic purpura, isoimmunization, and transfusion-associated cardiac overload occur with increased frequency in pregnant mothers. Transfusion requirement around peripartum period is uncertain and sometimes could be massive. Hence, both obstetrician and transfusion experts should remain prepared for this eventuality. Transfusion of blood products even though has never been safer than it is today; yet, this procedure carries with it many immunological, infectious, and other complications, hence, should be used judiciously and very cautiously. Several procedures such as apheresis and intraoperative cell salvage are being increasingly used nowadays for various facets of management and obstetric care. Present review condenses on the knowledge of usage of blood and blood products in obstetric care.