No abstract

(Anaesthesia. 2016;71:648–656) Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Depletion of coagulation factors and platelets can occur during obstetric hemorrhage. Reduction in coagulation factors and its management by replacement with fresh frozen plasma, cryoprecipitate, and fibrinogen concentrate have been addressed in earlier studies. However, there are few data addressing the need for platelet transfusion during postpartum hemorrhage. Current guidelines suggest transfusion may be indicated when the platelet count is <75×109/L. This study evaluated data from a previous study investigating the effect of fibrinogen on postpartum hemorrhage progression to assess the association between baseline platelet count and the need for platelet transfusion during postpartum hemorrhage.

SummaryLimited data exist on platelet transfusion during postpartum haemorrhage. We retrospectively analysed a consecutive cohort from a single centre of 347 women with moderate or severe postpartum haemorrhage, transfused according to national guidelines. Twelve (3%) women required a platelet transfusion. There were no differences between women who did and did not receive platelets with respect to age, mode of initiation of labour or mode of delivery. Women receiving a platelet transfusion had a lower median (IQR [range]) platelet count at study entry than women who did not receive platelets before haemorrhage (135 (97-175 [26-259] .l À1 respectively). Six women were thrombocytopenic pre-delivery. The cause of haemorrhage that was associated with the highest rate of platelet transfusion was placental abruption, with three of 14 women being transfused. If antenatal thrombocytopenia or consumptive coagulopathy were not present, platelets were only required for haemorrhage > 5000 ml. Early formulaic platelet transfusion would have resulted in many women receiving platelets unnecessarily. Using current guidelines, the need for platelet transfusion is uncommon without antenatal thrombocytopenia, consumptive coagulopathy or haemorrhage > 5000 ml. We found no evidence to support early fixed-ratio platelet transfusion.

No abstract

The field of heart transplantation has seen considerable innovation over the years. Understanding the wide range of presentations in patients who have undergone operations we now consider historical remains important. This case illustrates the complexities of management in a patient with a previous heart transplant who presented with ventricular tachycardia. ( Level of Difficulty: Advanced. )