Management of Parturients Who Decline Blood Transfusion
OAA National Survey 122
A Jennings & C Brennan
Introduction
• Increased morbidity and mortality
• Require particular management
Methods
• OAA National Survey 122• Sent to lead obstetric anaesthetists
Survey Objective
• To establish current UK anaesthetic practice when managing JWs – Consent– Pre-optimisation– Anaesthetic technique– Facilities available– Seniority of staff involved
Response rate 70%
Antenatal Care
Majority• Have a policy – 85%• Use specific “no blood”
consent form – 85% • See patients in clinic –
70%
Minority• Routinely administer
prophylactic haematinics – 36%
• Erythropoietin (if anaemic) – 20%
In a ‘High Risk’ LSCS…
Empirical additional uterotonics
Prophylactic interventional radiology
Peri-operative cell salvage
General anaesthesia
Invasive monitoring
Transfer
49%
28%
78%
18%
8%
20%
Senior Input
What is deemed mandatory in all cases?• Consultant anaesthetist-led
theatre care: 30%• Consultant obstetrician-led
surgery: 24% • Consultant haematologist
notified: 23%
Facilities– Cell Salvage
‘Continuous connectivity’ mode• Discuss antenatally: 53%• Provide a 24hr service: 21%• No cell salvage at all: 25%
Facilities– Interventional Radiology
24-hour access to interventional radiology service: 27%
Postnatal Syntocinon Infusion
Routine use in:• Caesarean Section: 48%• All forms of delivery: 22%
Centralisation of Services?
• 42% felt JWs should be managed in specified regional centres where appropriate facilities, staffing and expertise are guaranteed 24-7.
Conclusion
• Substantial variation in management demonstrated
• Many units are not equipped to meet the JW care plan
• Substantial support for centralisation of services for JWs. This is worthy of further discussion.
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