Platelet count and transfusion requirements during moderate or severe postpartum haemorrhage

Jones, Rachel; Lloyd, L. de; Kealaher, E.J.; Lilley, Graeme; Precious, Elizabeth; Laurent, D. Burckett st; Hamlyn, Vincent; Collis, Rachel; Collins, Peter William

doi:10.1111/anae.13448

Cited by 31 publications

(12 citation statements)

References 31 publications

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“…One third of women was thrombocytopenic and many were severely thrombocytopenic. This also contrasts with studies in high income countries in which thrombocytopenia is relatively uncommon [ 24 ]. The low platelet counts (in the context of the relatively well preserved coagulation factors) may explain why so many women had an EXTEM A5 < 40 mm since EXTEM A5 values are influenced by platelet and fibrinogen levels.…”

Section: Discussioncontrasting

confidence: 73%

Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage

Roberts

Shakur

Fawole

et al. 2018

BMC Pregnancy Childbirth

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BackgroundEarly treatment with tranexamic acid reduces deaths due to bleeding after post-partum haemorrhage. We report the prevalence of haematological, coagulation and fibrinolytic abnormalities in Nigerian women with postpartum haemorrhage.MethodsWe performed a secondary analysis of the WOMAN trial to assess laboratory data and rotational thromboelastometry (ROTEM) parameters in 167 women with postpartum haemorrhage treated at University College Hospital, Ibadan, Nigeria. We defined hyper-fibrinolysis as EXTEM maximum lysis (ML) > 15% on ROTEM. We defined coagulopathy as EXTEM clot amplitude at 5 min (A5) < 40 mm or prothrombin ratio > 1.5.ResultsAmong the study cohort, 53 (40%) women had severe anaemia (haemoglobin< 70 g/L) and 17 (13%) women had severe thrombocytopenia (platelet count < 50 × 109/L). Thirty-five women (23%) had ROTEM evidence of hyper-fibrinolysis. Based on prothrombin ratio criteria, 16 (12%) had coagulopathy. Based on EXTEM A5 criteria, 49 (34%) had coagulopathy.ConclusionOur findings suggest that, based on a convenience sample of women from a large teaching hospital in Nigeria, hyper-fibrinolysis may commonly occur in postpartum haemorrhage. Further mechanistic studies are needed to examine hyper-fibrinolysis associated with postpartum haemorrhage. Findings from such studies may optimize treatment approaches for postpartum haemorrhage.Trial registrationThe Woman trial was registered: NCT00872469; ISRCTN76912190 (Registration date: 22/03/2012).

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Section: Discussioncontrasting

confidence: 73%

Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage

Roberts

Shakur

Fawole

et al. 2018

BMC Pregnancy Childbirth

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“…Postpartum haemorrhage may be exacerbated by haemostatic impairment. A Clauss fibrinogen below 2 g/L is associated with progression of bleeding [12,13], although clinically significant deficiencies of other clotting factors and platelets are less common [14][15][16]. In severe PPH, laboratory coagulation results are often too slow to be useful clinically and guidelines recommend the use of empirical treatment with fixed ratios of red blood cells (RBC), fresh frozen plasma (FFP) and platelets, based on data derived from major trauma [5,6].…”

Section: Introductionmentioning

confidence: 99%

Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study

Bell

Collis

Pallmann

et al. 2021

BMC Pregnancy Childbirth

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Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion. Methods A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data. Results Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment. Conclusions The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes.

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“… 52 Usually, the platelet counts will decrease to the baseline level approximately 1 week after platelet transfusion. 53 Concurrent administration of platelet transfusions and IVIg was associated with resolution of bleeding, rapid restoration of adequate platelet counts, and minimal side effects. 16 In our study, the predelivery platelet transfusion of the IVIg monotherapy group was greater than that of the prednisone plus IVIg group.…”

Section: Discussionmentioning

confidence: 94%

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study

Zhu

Feng

Huang

et al. 2022

Therapeutic Advances in Hematology

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Background: The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg versus prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP). Methods: Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone. Results: Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; p < 0.001), and between the IVIg group (6.71 ± 4.85 days) and prednisone group ( p < 0.001). The median prednisone duration in the monotherapy group was 27 days (range, 8–195 days), whereas that in the combination group was 14 days (range, 6–85 days). No significant differences were found among these three treatment groups in neonatal outcomes, particularly concerning the neonatal platelet counts. The time to response in the combination treatment group was shorter than prednisone monotherapy. The duration of prednisone application in combination group was shorter than prednisone monotherapy. The combined therapy showed a lower predelivery platelet transfusion rate than IVIg alone. Conclusion: These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.

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Platelet count and transfusion requirements during moderate or severe postpartum haemorrhage

Cited by 31 publications

References 31 publications

Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage

Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage

Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study

Prednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study

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