Asian Journal of Transfusion Science
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ORIGINAL ARTICLE
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Massive transfusion protocol for postpartum hemorrhage case management in Hospital Kuala Lumpur; Five years implementation and outcome


1 Clinical Transfusion Division, National Blood Centre, Kuala Lumpur, Malaysia
2 Department of Obstetric & Gynaecology Tengku Azizah Hospital, Kuala Lumpur, Malaysia
3 Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
4 Department of Anesthesiology Tengku Azizah Hospital, Kuala Lumpur, Malaysia

Correspondence Address:
Nor Hafizah Ahmad,
Clinical Transfusion Division, National Blood Centre, Jalan Tun Abdul Razak, 50400 Kuala Lumpur
Malaysia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_102_21

CONTEXT: Postpartum hemorrhage (PPH) is a global cause of mortality and morbidity and the number remains high despite the advancement in medical field. Literature suggested that the causes of PPH were largely avoidable and measures can be instituted to avoid it. Transfusion service played an integral part to ensure that blood and blood products were supplied in timely manner. AIMS: The study aimed to look into the role of massive transfusion protocol (MTP) in facilitating blood supply during acute management of bleeding in PPH cases. SETTINGS AND DESIGN: This was a retrospective study of 5 years on MTP implementation in the management of PPH in Hospital Kuala Lumpur (HKL). SUBJECTS AND METHODS: We analyzed the patient's clinical records from Transfusion Medicine database starting from April 1, 2015, to December 31, 2019, at the Obstetrics and Gynecology (O and G) Department, HKL. STATISTICAL ANALYSIS USED: The data were presented as numbers or percentages, mean (standard deviation), and median (interquartile range). Pearson's correlation was used to assess correlation between the total estimated blood loss and the number of red cell concentrates transfused. Multinomial logistic regression analysis was used to study the association of parity and mode of delivery with the transfusion requirement in the MTP cycle. RESULTS: In total, there were 54,417 deliveries during the study period. MTP activation only occurred in 60 cases with 5 exclusions. Therefore, activation occurred in 55 PPH cases at a rate of 0.001% out of the total number of deliveries. The most common etiology of PPH was uterine atony. Only one patient in the cohort died due to postoperative complication of intra-abdominal sepsis. Morbidities from hysterectomy were documented in 15 cases (27.3%), and there was intensive care unit admission in 22 cases (40%). Wastage of blood and blood products was very minimal; 8/341 units fresh frozen plasma were discarded (2.35%) and 8/332 units platelet were discarded (2.4%). CONCLUSIONS: The study outcome showed that an MTP designed specific to obstetric service had helped improve patient outcomes and reduce overall transfusion rate as it helped improve blood availability early during the event as part of the hemostatic resuscitation.


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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006