Transfusion of Whole Blood and Cesarean Delivery: A Retrospective Review
Condition: Obstetric Labor Complications
MeSH terms: Obstetric Labor Complications
Study type: Observational

Summary: 
      The rate of postpartum hemorrhage (PPH) has risen dramatically in the developed world, along
      with a rise in blood transfusion rates. The rate of cesarean delivery has increased
      dramatically in the past decade and is well over 30% in the United States. With an increase
      in primary and repeat cesarean delivery, comes the added risk of abnormal placentation, which
      can contribute to maternal and fetal morbidity and mortality via placenta accreta, increta,
      and percreta. The incidence of accreta has increased 10-fold over the past 50 years, becoming
      the most common reason for cesarean hysterectomy in highly industrialized countries. These
      conditions have tremendous impact on maternal outcomes.

      Although whole blood (WB) contains all of the individual blood components, there are concerns
      for the use of WB due to the potential limitations such as the hemostatic efficacy of
      platelet after cold storage, the risk of hemolytic transfusion reaction following the
      transfusion of un-cross matched WB and the logistical issues in providing WB. Traditional
      obstetric transfusion protocols involve blood component therapy. Whole blood contains all
      components and could be more efficient for massive transfusion in obstetric hemorrhage.
      Trauma resuscitation protocols mimic whole blood in the 1:1:1 transfusion protocols of packed
      red blood cells to plasma to platelet ratio. It is difficult to compare trauma resuscitation
      to obstetric hemorrhage, but both can involve significant resuscitation and serious sequelae
      from unnecessary transfusion.

      The use of WB instead of component therapy may reduce the multiple organ dysfunction rates
      due to the rapid resolution of shock and coagulopathy. Additionally, the number of donor
      exposure is important factor for the transfusion-related allergic reactions including severe
      systemic reactions such as anaphylaxis. Use of WB may decrease number of donor exposure. The
      secondary aim is to compare the incidence of 3 common adverse outcomes associated with the
      transfusion of blood products in subjects who receive whole blood versus component therapy.

      Investigators hypothesize that the patients receiving WB will have fewer incidences of a)
      acute renal failure, b) acute heart failure and c) transfusion-related lung disease compared
      to those receiving component therapy.
    

Detailed description: 
      This is a retrospective cohort study. There is no research-related interventions. Data was
      collected retrospectively via the electronic medical records of the subjects who underwent
      cesarean delivery, and also received a blood transfusion during the intraoperative and
      postoperative periods between January 1, 2010 through December 1, 2016. Parkland Hospital
      Office of Research Administration pulled to data from eligible subjects' medical record based
      on ICD or CPT codes. Retrospective cohort was grouped as whole blood therapy and component
      therapy.

      The data from the Electronic Medical Record pertaining to maternal characteristics includes
      demographic information, history of risk factors for PPH, prepartum and postoperative
      laboratory values, characteristic of cesarean section, type of the anesthesia utilized, Blood
      group, type and amounts of the blood products given, type of the components, how many overall
      units are given during the intraoperative period, need for an intraoperative hysterectomy,
      length of total hospital stay, evidences of hemolytic reaction caused by transfusion, the ICD
      10 diagnosis of acute renal failure, acute heart failure due to volume overload, and
      transfusion-related lung disease (TRALI) on the discharge summary.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        This is a retrospective study. Data retrospectively collected from medical record of the
        subjects underwent cesarean delivery and also received a blood transfusion or blood
        component therapy in the period between January 1, 2015 through January 1, 2016