Managing Complications in Pregnancy and Childbirth: - IAWG

C-26 Clinical use of blood, blood products and replacement fluidsThe fundamental principle of the appropriate use of blood or bloodproduct is that transfusion is only one element of the woman’smanagement. When there is sudden rapid loss of blood due tohaemorrhage, surgery or complications of childbirth, the most urgentneed is usually the rapid replacement of the fluid lost from circulation.Transfusion of red cells may also be vital to restore the oxygen-carryingcapacity of the blood.Minimize “wastage” of a woman’s blood (to reduce the need fortransfusion) by:• using replacement fluids for resuscitation;• minimizing the blood taken for laboratory use;• using the best anaesthetic and surgical techniques to minimizeblood loss during surgery;• salvaging and reinfusing surgical blood lost during procedures(autotransfusion), where appropriate (page S-14).Principles to remember:• Transfusion is only one element of managing a woman.• Decisions about prescribing a transfusion should be based onnational guidelines on the clinical use of blood, taking the woman’sneeds into account.• Blood loss should be minimized to reduce the woman’s need fortransfusion.• The woman with acute blood loss should receive effectiveresuscitation (IV replacement fluids, oxygen, etc.) while the needfor transfusion is being assessed.• The woman’s haemoglobin value, although important, should notbe the sole deciding factor in starting the transfusion. The decisionto transfuse should be supported by the need to relieve clinicalsigns and symptoms and prevent significant morbidity andmortality.• The clinician should be aware of the risks of transfusiontransmissibleinfection in blood products that are available.• Transfusion should be prescribed only when the benefits to thewoman are likely to outweigh the risks.• A trained person should monitor the transfused woman andrespond immediately if any adverse effects occur (page C-27).