[CG] Blood ordering schedule, Obstetrics

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Key Points:

  1. 84% of blood cross matched for obstetric patients is currently returned unused to Blood Bank
  2. Fully cross matched blood can be available for collection from Blood Bank in 45 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  3. Group specific blood can be available for collection from Blood Bank in 20 minutes from receipt of request – as long as the laboratory have a valid sample (<72 hrs old)
  4. There are 3 units of O Negative blood in the labour ward fridge
  5. The GGC Major Haemorrhage protocol will cross match up to 6 units of packed red cells if requested – please specify requirements depending on clinical case
  6. Indication must ALWAYS be specified on request to provide laboratory with accurate clinical detail
  7. Blood loss should be estimated by weighing swabs, drapes etc.
  8. Odd numbers as well as even numbers can be requested and given
  9. It is rare for obstetric patients to require more than 2 units of blood , even with PPH
  10. Dereserving cross matched blood promptly when clinically appropriate reduces waste

Recommendations: 
ALL WOMEN IN LABOUR SHOULD HAVE A ROUTINE GROUP AND SAVE

The following DO NOT require routine cross matching:

Asymptomatic Placenta Praevia on ward

G&S

Examination under anaesthetic

G&S

Multiple pregnancy in labour

G&S

Retained placenta without PPH

G&S

Elective LUSCS

G&S

Emergency LUSCS 

G&S

Haemophilia carrier – normal FVIII/FIX

G&S

Von Willebrand Disease – normal FVIII/vWF

G&S

Therapeutic heparin in labour

G&S

Platelet count 50-80 x 109/L

G&S

Platelet count < 50 x 109/L in labour

Discuss with Consultant Obstetrician and Haematologist and ensure Anaesthetic team are aware. Follow specific antenatal plan for patient

Prolonged rupture of membranes in labour

G&S

Pre-eclampsia without haemolysis or haemorrhage 

G&S

Preterm delivery

G&S

Induction of labour

G&S

Fibroids – < 4cm in body of uterus

G&S

 

Organise cross matched blood if:

APH with ongoing bleeding

2 units

Major APH 

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS with abnormally invasive placental disease

Minimum of 4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

Minimum of 2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units

CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liase with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Please be mindful that some patients will have multiple risk factors which may influence clinical decision making around blood ordering . Each case is unique and there is a balance to be achieved between blood product wastage and patient safety .A degree of clinical independence is reasonable.

Appendix 1

Organise Cross Matched Blood if:

Organise cross matched blood if:

APH with ongoing bleeding

2 units

Major APH (e.g. heavy PV bleeding, IV fluids required) +/- additional risk factor, unstable

4 units

Emergency ERPOC

1-2 units if most senior Obstetrician or Anaesthetist requests this

LUSCS for placenta praevia

2 units NB–if no PPH at delivery, blood should be dereserved after maximum 24 hours

LUSCS for suspected accreta

4 units

PPH >1500ml with ongoing significant bleeding

Consider major haemorrhage protocol at 1500ml and activate if ongoing bleeding

2 units

Haemophilia carrier – Low FVIII/FIX

2 units

Von Willibrand’s Disease – reduced FVIII/vWF

2 units

CS with fibroids – ≥ 4cm in the lower segment or multiple fibroids

2 units

In the case of procedures where blood is not routinely required it can be requested if deemed clinically necessary

PPH 500 -1500ml without ongoing bleeding

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

Red cell antibodies present

Liase with Blood Bank to avoid delays in transfusion

LUSCS or labour where Hb <80g/L

G&S and check Hb postpartum

If clinically stable, refer to Postpartum Blood Transfusion in Stable Patients Guideline

 

Last reviewed: 08 August 2019

Next review: 30 June 2022

Author(s): Dr Judith Roberts, Consultant Obstetrician, QEUH

Version: 3

Approved By: GONEC