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  • PART IX Obstetric: Complications

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    Siti Barokah
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    This document presents a sample algorithm for a massive transfusion protocol (MTP) for managing obstetric complications involving heavy bleeding in a labor and delivery unit. The algorithm outlines the steps to activate the MTP which includes initial testing, initiating transfusion of 6 units of red blood cells, 4 units of fresh frozen plasma, and 1 platelet unit. It then provides guidance on additional testing and transfusion based on coagulation factor levels to control bleeding while closely monitoring the patient's status and lab results. The goal is to quickly provide necessary blood products and treatments to stabilize the patient while avoiding unnecessary transfusions.

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    massive blood transfusion

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    905

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    This document presents a sample algorithm for a massive transfusion protocol (MTP) for managing obstetric complications involving heavy bleeding in a labor and delivery unit. The algorithm outlines the steps to activate the MTP which includes initial testing, initiating transfusion of 6 units of red blood cells, 4 units of fresh frozen plasma, and 1 platelet unit. It then provides guidance on additional testing and transfusion based on coagulation factor levels to control bleeding while closely monitoring the patient's status and lab results. The goal is to quickly provide necessary blood products and treatments to stabilize the patient while avoiding unnecessary transfusions.

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    © All Rights Reserved
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    7 views1 page

    PART IX Obstetric: Complications

    Uploaded by

    Siti Barokah
    This document presents a sample algorithm for a massive transfusion protocol (MTP) for managing obstetric complications involving heavy bleeding in a labor and delivery unit. The algorithm outlines the steps to activate the MTP which includes initial testing, initiating transfusion of 6 units of red blood cells, 4 units of fresh frozen plasma, and 1 platelet unit. It then provides guidance on additional testing and transfusion based on coagulation factor levels to control bleeding while closely monitoring the patient's status and lab results. The goal is to quickly provide necessary blood products and treatments to stabilize the patient while avoiding unnecessary transfusions.

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    © All Rights Reserved
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    906 PART IX Obstetric Complications

    DIC panel (1 blue top tube)


    PT
    PTT
    Fibrinogen
    Laboratorium klinik Thrombin time
    D-dimer
    CBC (1 lavender top tube)
    Resiko perdarahan tak terkontrol ABG (heparinized syringe)
    aktivasi tim medis
    mulai pengambilan darah

    jenis dan crossmatch


    Pelayanan transfusi (1 lavender tube)

    IIndikasi tidak Resusitasi konvesional


    Transfusi
    sambil dievaluasi
    segera?

    ya

    Antisipasi
    Total kebutuhan
    >10 RBC units?

    tdk Resusitasi konvesional


    Butuh MTP? Reevaluasi pada intervals
    pertimbangan kembali MTP

    ya
    ya
    Aktivasi MTP dg paket
    initialMTP
    6 units RBCs
    4 units FFP
    1 apheresis PLT unit

    lab inisial: jika INR >1.5* Ijika Platelet < 25,000/mm3 jika fibrinogen <100 mg/dL
    PT/PTT/Fibrinogen/D-dimer - berikan 4 units FFP - berikan 1 apharesis - berikan 10 pack
    (1 blue top tube) *ulangi sampai unit untuk cryoprecipitate untuk
    CBC (1 lavender tube) INR terkontrol meningkatkan PLTs meningkatkan fibrinogen
    25-30,000/mm3

    Hasil lab dalam tidak


    batas normal?

    ya

    Ulangi Inisial MTP Pack*


    ya
    antisipasi perdarahan *pertimbangkan
    ulangi labs
    yg berlangsung? rFVIIa sebagai terapi
    penyelamatan

    tidak

    Deaktivasi MTP Pelayanan transfusi untuk


    kriteria: Nilai lab Normal mengecek tim jika MTP belum
    dan atau tanpa evidens di deaktivasi dan tidak ada
    ongoing bleeding produk yang dikirim > 60 menit

    FIGURE 38-5 ■ Sample algorithm for a massive transfusion protocol for the labor and delivery unit. ABG, arterial blood gas; CBC,
    complete blood cell count; DIC, disseminated intravascular coagulation; FFP, fresh frozen plasma; INR, international normalized
    ratio; MTP, massive transfusion protocol; PLT, platelet; PT, prothrombin time; RBC, red blood cells; rFVIIA, recombinant activated
    factor VII. (Modified from Burtelow M, Riley E, Druzin M, et al. How we treat: management of life-threatening primary postpartum hemor-
    rhage with a standardized massive transfusion protocol. Transfusion 2007; 47:1564-72.)

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