DÄ internationalArchive7/2009Emergencies Associated With Pregnancy and Delivery – Peripartum Hemorrhage: Different Products

Correspondence

Emergencies Associated With Pregnancy and Delivery – Peripartum Hemorrhage: Different Products

Dtsch Arztebl Int 2009; 106(7): 113. DOI: 10.3238/arztebl.2009.0113a

Ostendorf, N

LNSLNS The terms cryoprecipitates and prothrombin complex concentrates (PPSB) cannot be used synonymously; they refer to two totally different products. Cryoprecipitates are rich in fibrinogen but have ceased to be available as a routine preparation several years ago. PPSB do not contain fibrinogen or fibronectin. The authors do recommend the separate administration of fibrinogen elsewhere in the text. However, they do not mention that if larger amounts of PPSB are substituted, antithrombin should be substituted as well (1).

The statement "In emergencies, patients are given uncrossed O-negative packed cells. It should be remembered that the blood group is usually known since it is entered in the patient's maternity record card" is doubtful: The blood group is certainly recorded in the maternity record card, but an immunohematological laboratory has an obligation to check the blood group before providing erythrocyte concentrates (EC) (2). The sentence could be misinterpreted to mean that EC of the supposed patient’s blood group can be administered without crossmatch.

If a patient is in danger of bleeding to death, O-negative packed red cells are given without crossmatch, with a residual risk of antibodies to Rhesus-c or -e. The maternity pass should be consulted for antibody testing. Before emergency transfusion, a blood sample should be taken because otherwise O-EC will also have to be used for further transfusions.

If there are a few minutes to spare, the patient's blood group can be determined in the in-house laboratory. If the patient is known to the hospital, her AB0 and RH blood group are likely to be known. In that case, blood group matched EC can be given without crossmatch. The EC should—if possible—be compatible for Rhesus subgroups, to avoid immunizations.
DOI: 10.3238/arztebl.2009.0113a

Dr. med. Norbert Ostendorf
St. Katharinen-Hospital GmbH
Kapellenstr. 1–5
50226 Frechen, Germany
Ostendorf@khs-frechen.de
1.
Vorstand und wissenschaftlicher Beirat der Bundes­ärzte­kammer (Hrsg.): Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. http://www.bundesaerztekammer.de/page.asp?his=0.6.3288.6716
2.
Bundes­ärzte­kammer und Paul-Ehrlich Institut: Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Hämotherapie). http://www.bundesaerztekammer.de/page.asp?his=0.6.3288.6716
3.
Kainer F, Hasbargen U: Notfälle in der Geburtshilfe – peripartale Blutungen. Dtsch Arztebl 2008; 105(37): 629–38.
1. Vorstand und wissenschaftlicher Beirat der Bundes­ärzte­kammer (Hrsg.): Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. http://www.bundesaerztekammer.de/page.asp?his=0.6.3288.6716
2. Bundes­ärzte­kammer und Paul-Ehrlich Institut: Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Hämotherapie). http://www.bundesaerztekammer.de/page.asp?his=0.6.3288.6716
3. Kainer F, Hasbargen U: Notfälle in der Geburtshilfe – peripartale Blutungen. Dtsch Arztebl 2008; 105(37): 629–38.