Evaluation of gynecology and gynecologic oncology cases who received massive blood transfusion: a tertiary center experience

Year 2023, , 405 - 410, 27.10.2023

İzzet Özgürlük , Hüseyin Levent Keskin

https://doi.org/10.38053/acmj.1347060

Abstract

Aims: To examine the frequency, indications and results of massive blood transfusion in gynecology and gynecological oncology cases.
Methods: The data of 56 cases who were underwent massive blood transfusion and operated on for benign/ malignant pathology indications in the gynecology and gynecological oncology clinics between October 1, 2022 and August 1, 2023, within a period of 10 months, were retrospectively analyzed. Demographic data of the cases (age, gravida, parity, body mass index), indications for hospitalization, vital signs during hospitalization, hemoglobin (Hb), hematocrit (Htc), platelet and INR values, massive transfusion indications, transfused blood products (erythrocyte suspansion, fresh frozen plasma (FFP), pooled platelet suspension, cryoprecipitate, fibrinogen) and the length of stay in the intensive care unit and hospitalization were retrospectively screened and analyzed statistically. The statistical significance level was accepted as p<0.05.
Results: 56 (1.8%) of 3146 patients were received massive blood transfusion. Massive blood transfusion was given to 30 (1.4%) of 2093 inpatients in the gynecology clinic, while this rate was found to be 2.5% (26/1053) in gynecologic oncology patients. The time between the decision to start transfusion and total transfusion times were similar between the groups (p>0.05). However, when the decision for transfusion was made, the INR value was statistically significantly higher in gynecological oncology cases (p=0.001). While the amounts of erythrocyte suspension given were similar between the two patient groups (5.1±1.4 vs. 6.3±3.5 U, p= 0.082), FFP amounts were higher in the gynecologic oncology group (3.3±2.0 vs. 6.2±3.7 U, p=0.001). When the blood groups of the cases were examined, it was seen that the most common blood groups were O (+) (n= 18, 32.1%) and A (+) (n=16, 28.6%). The duration of stay in the intensive care unit and hospitalization of gynecological oncology cases was significantly longer in gynecological cases. While 1 of 56 patients who underwent massive blood transfusion died (gynecological oncology case), 55 patients were discharged.
Conclusion: Timely transfusion decision is safe and life-saving in massive hemorrhages.

Keywords

Gynecology, gynecologic oncology, massive blood transfusion

References

• Waters JH, Bonnet MP. When and how should I transfuse during obstetric hemorrhage?. Int J Obstet Anesth. 2021;46:102973. doi:10.1016/j.ijoa.2021.102973
• Critical Bleeding/Massive Transfusion”; T.R. Ministry of Health, General Directorate of Health Services, Department of Blood and Blood Products, Patient Blood Management Guide: Module 1: Ankara, Ünlü A, Çetin AT, Yenicesu İ, Ertuğrul Örüç N, Balas Ş. January 2023; page: 26 [Internet: Patient Blood Management Guide: Module 1 (saglik.gov.tr)
• Gökçebay D, Tekgündüz S, Yaşar S, Bolaç S, Işın U. Evaluation of Hospital Staff’s Awareness on Blood Product Transfusion. Academic Res Med. 2016;3(1):100-105
• Turkish Society of Hematology. Supportive therapies and infections in hematology course guide 2007:164-176.
• Mojdehbakhsh RP, Al-Rubaye R, Huang DS, Connor J, Al-Niaimi A. Efficacy and safety of a restrictive blood transfusion protocol in gynecologic surgical patients. Gynecol Oncol Rep. 2022;43:101059. doi:10.1016/j.gore.2022.101059
• Spahn DR, Goodnough LT. Alternatives to blood transfusion. Lancet. 2013;381(9880):1855-1865. doi:10.1016/S0140-6736(13)60808-9
• Leahy MF, Hofmann A, Towler S, et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion. 2017;57(6):1347-1358. doi:10.1111/trf.14006
• Spahn DR. Patient Blood Management: the new standard. Transfusion. 2017;57(6):1325-1327. doi:10.1111/trf.14095
• Pham HP, Shaz BH. Update on massive transfusion. Br J Anaesth. 2013;111 Suppl 1:i71-i82. doi:10.1093/bja/aet376
• Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-482. doi:10.1001/jama.2015.12
• Mesar T, Larentzakis A, Dzik W, Chang Y, Velmahos G, Yeh DD. Association between ratio of fresh frozen plasma to red blood cells during massive transfusion and survival among patients without traumatic injury. JAMA Surg. 2017;152(6):574-580. doi:10.1001/jamasurg.2017.0098
• Pham HP, Shaz BH. Update on massive transfusion. Br J Anaesth. 2013;111 Suppl 1:i71-i82. doi:10.1093/bja/aet376
• Mesar T, Larentzakis A, Dzik W, Chang Y, Velmahos G, Yeh DD. Association between ratio of fresh frozen plasma to red blood cells during massive transfusion and survival among patients without traumatic injury. JAMA Surg. 2017;152(6):574-580. doi:10.1001/jamasurg.2017.0098
• Zaidi A, Kohli R, Daru J, et al. Early use of fibrinogen replacement therapy in postpartum hemorrhage-a systematic review. Transfus Med Rev. 2020;34(2):101-107. doi:10.1016/j.tmrv.2019.12.002
• Kovalic AJ, Khan MA, Malaver D, et al. Thromboelastography versus standard coagulation testing in the assessment and reversal of coagulopathy among cirrhotics: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2020;32(3):291-302. doi:10.1097/MEG.0000000000001588
• Van Haren RM, Valle EJ, Thorson CM, et al. Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism. J Trauma Acute Care Surg. 2014;76(2):443-449. doi:10.1097/TA.0b013e3182a9d11d
• Wise R, Bishop D, Gibbs M, et al. South African Society of Anaesthesiologists perioperative patient blood management guidelines. SAJAA. 2020;26:1-59. doi: 10.36303/SAJAA.2020.26.6.S1
• Lopez-Picado A, Albinarrate A, Barrachina B. Determination of perioperative blood loss: accuracy or approximation?. Anesth Analg. 2017;125(1):280-286. doi:10.1213/ANE.0000000000001992
• Swift BE, Maeda A, Bouchard-Fortier G. Adverse postoperative outcomes associated with perioperative blood transfusion in gynecologic oncology surgery. Int J Gynecol Cancer. 2023;33(4):585-591. doi:10.1136/ijgc-2022-004228