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Usefulness of shock indicators for determining the need for blood transfusion after massive obstetric hemorrhage
Author(s) -
Era Sumiko,
Matsunaga Shigetaka,
Matsumura Hideyoshi,
Murayama Yoshihiko,
Takai Yasushi,
Seki Hiroyuki
Publication year - 2015
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12480
Subject(s) - medicine , fibrinogen , coagulopathy , shock (circulatory) , blood volume , blood transfusion , hematocrit , fresh frozen plasma , coagulation testing , coagulation , intravascular volume status , intensive care medicine , platelet , hemodynamics
Aim Massive obstetric hemorrhage ( MOH ) requires prompt transfusion of red blood cells and coagulation factors. Because MOH has a diverse pathogenesis, the shock index ( SI ) alone may be insufficient for determining blood transfusion. Here, we retrospectively analyzed patients with MOH to determine usefulness of the indicators of shock including the SI in evaluating the need for blood transfusion. Methods We reviewed records of 80 emergency referral patients who had received blood transfusions at our department between 1 J anuary 2009 and 31 J uly 2011. The shock indicators for blood transfusion are estimated blood loss, fibrinogen level, hemoglobin concentration, the J apan S ociety of O bstetrics and G ynecology disseminated intravascular coagulation ( JSOG DIC ) score and the SI . The strength of the correlation of each shock indicator with the transfusion volume was ranked using Spearman's rank correlation coefficient‐ρ and multivariate analysis. Results Although the SI showed significant positive correlation with blood transfusion volume for red blood cell concentrate ( RCC ) and fresh frozen plasma ( FFP ) in patients with dilutional coagulopathy, a stronger correlation was seen with the fibrinogen level and JSOG DIC score. In patients with consumptive coagulopathy, the strongest correlation was seen between RCC transfusion volume and fibrinogen level, and between FFP transfusion volume and JSOG DIC score followed by fibrinogen level. In multivariate analysis, only fibrinogen level was significantly associated with both RCC and FFP massive transfusion. Conclusion Because MOH has a diverse pathogenesis, various indicators should be evaluated. Among shock indicators, fibrinogen level was the best indicator of the need for blood transfusion following MOH .