The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: a population based study
Abstract
Understanding the coagulopathy of major-obstetric-haemorrhage (MOH) that leads to massive-transfusion (MT) is fundamental to improving outcomes. This study reports on the haematological features and transfusion management of women experiencing MT [defined as transfusion of ≥8 units of red blood cells (RBC) within 24 h of delivery]. One hundred and eighty-one cases [median (interquartile range; IQR) age 33 years (29-36)] were identified from all UK hospitals, using the UK Obstetric Surveillance System between July 2012 and June 2013. The median (IQR) estimated blood loss was 6 l (4·5-8). At presentation, the median platelet count was lowest for placenta accreta, compared with other causes, while the median prothrombin time and fibrinogen were <1·5 × mean normal and <3 g/l, respectively for all aetiologies. Median platelet count and fibrinogen fell to <75 × 10(9) /l and <2 g/l, respectively for all causes during bleeding, except for trauma. The median (IQR) units of RBC, fresh-frozen-plasma (FFP) and cryoprecipitate transfused were 10 (8-14), 6 (4-8) and 2 (2-4), respectively. The median time from the onset of bleeding to delivery of the first RBC unit was significantly shorter for women who delivered via elective caesarean section, compared with others. The coagulopathy of MT during MOH differs significantly depending on its cause, suggesting that more targeted transfusion strategies are required.
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Compared to other causes of obstetrical hemorrhage, pregnant people with significant abruption experience greater decreases in platelets, require more platelet transfusions, and have more acquired hypofibrinogenemia.
“Compared to other causes of obstetrical hemorrhage, pregnant people with significant abruption experience greater decreases in platelets, require more platelet transfusions, and have more acquired hypofibrinogenemia (95–97).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [97]
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Bhat, A. D., Farber, M. K., & Kowalczyk, J. J. (2026) · Anesthesiology Clinics · doi:10.1016/j.anclin.2026.04.005
A New Severity Index for Placental Abruption Predicts Recurrence Risk in Future Pregnancies
Kerber, L., Rippel, S., Cohen, O., Rokach, L., Spiegel, E., Avnon, T., & Erez, O. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15135308
- Authors
- Green, L., Knight, M., Seeney, F., Hopkinson, C., Collins, P. W., Collis, R. E., Simpson, N. A. B., Weeks, A., & Stanworth, S. J.
- Affiliations
- NHS Blood and Transplant (GB)
- University of Oxford (GB)
- Cardiff University (GB)
- Cardiff and Vale University Health Board (GB)
- University of Leeds (GB)
- University of Liverpool (GB)
- Corresponding author
- Green, Laura
- ORCID
- Venue
- British Journal of Haematology
- Publisher
- Wiley
- Published
- 2015-12-18
- Volume
- 172
- Issue
- 4
- Pages
- 616-624
- ISSN
- 0007-1048 (ISSN-L)
- 1365-2141
- OpenAlex
- W2280937134
- Cited by
- 77
- References
- 18
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 8 · 2019: 8 · 2018: 12 · 2017: 7 · 2016: 8 · 2015: 1
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Haematology (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Funders
- NHS Blood and Transplant
- National Institute for Health Research
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Keywords
- major obstetric haemorrhage, massive transfusion, coagulopathy, transfusion management, red blood cell transfusion, fresh frozen plasma, cryoprecipitate, platelet count, fibrinogen, prothrombin time, placenta accreta, cesarean section, hemostasis
- MeSH terms
- Adult, Blood Transfusion, Female, Fibrinogen, Fluid Therapy, United Kingdom, Hemoglobins, Postpartum Hemorrhage, Humans, Pregnancy, Pregnancy Complications, Hematologic, Prothrombin Time, Retrospective Studies, Time Factors
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