Protocols are not just for show

Massive transfusion protocol updated, implemented for OB emergencies

The good news is that very few patients ever need a massive blood transfusion. Massive blood loss can occur, however, most often in cases of trauma, gastrointestinal bleeding, major surgery and obstetric hemorrhage.

The bad news is that massive blood loss is a major cause of potentially preventable death and must be managed carefully and quickly. Hallmark Health System had in headshotplace a protocol for managing massive transfusions, but last year clinical leaders reviewed and updated it based on statistics from the Massachusetts Department of Public Health that showed an uptick in maternal hemorrhages.

Dean Pappas, MD, medical director of the transfusion service, worked with several Hallmark Health clinical departments – including obstetrics, anesthesiology, surgery, emergency medicine and others – to review all the massive transfusion policies throughout the system.

“Some of our deliberations were straightforward,” said Dr. Pappas, “such as defining what constituted a massive transfusion – it’s when a patient needs more than three units of packed red blood cells. We also discussed details such as what other blood productsapositive a patient with a massive transfusion should get. We agreed on plasma and platelets for patients receiving four units of red blood cells.”

These policy refinements have been built into the protocol and are standard operating procedure. Also included in the new protocol are chain-of-notification instructions for who should be alerted to a potential hemorrhage case. “If a clinician thinks he or she will need more than two units of blood, the blood bank is notified immediately. The blood bank alerts the pathologist on call who can contact or go to the OR or elsewhere to assess the situation. The presence of the pathologist improves communication and makes the process more efficient, because speed counts in terms of patient safety in massive transfusions.”

The revised guidelines were not needed for a year and then were implemented twice this past summer, involving new mothers who experienced post-partum hemorrhage for very
different reasons. “In both cases, mothers and babies are fine,” said Dr. Pappas.”


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