BLOOD TRANSFUSION

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

Blood Transfusion in Obstetrics — A Practical Guide

Transfusion is often life-saving in obstetric haemorrhage and severe anaemia — but every component carries real risks, so it should be targeted to a clinical need, not given reflexively to correct a number. This guide covers components, compatibility testing, massive transfusion, and how to recognize a reaction early. For the haemorrhage side of this picture, see our companion Hemorrhagic Shock in Obstetrics guide.

🩸 AT A GLANCE — WHEN TO TRANSFUSE

Acute haemorrhage with instability: transfuse based on clinical status and ongoing loss — not a single lab value

Severe symptomatic anaemia (e.g., Hb <7 g/dL, or <8 g/dL with symptoms or cardiac disease) not responding to other measures

Planned transfusion for a known bleeding disorder or anticipated major blood loss (e.g., placenta accreta spectrum surgery)

GREEN: normal or mild anaemia, no active bleeding — oral iron and monitoring

AMBER: moderate anaemia or minor ongoing bleeding — consider transfusion based on symptoms and trend

RED: major haemorrhage or haemodynamic instability — transfuse urgently, activate massive transfusion protocol if criteria are met

Packed Red Cells (PRBC)

Restores oxygen-carrying capacity

One unit raises haemoglobin by roughly 1 g/dL

Fresh Frozen Plasma (FFP)

Replaces clotting factors

Used for coagulopathy and in massive transfusion

Platelets

For thrombocytopenia or platelet dysfunction with bleeding

Target often >50×10⁹/L for delivery/surgery; higher for neuraxial anaesthesia

Cryoprecipitate

Concentrated fibrinogen and factor VIII/XIII

Used when fibrinogen is low — remember pregnancy's normal fibrinogen runs higher, so "low-normal" may already be too low

🧯 MASSIVE TRANSFUSION PROTOCOL (MTP)

Typical Activation Criteria

Anticipated need for >4 units PRBC within 1 hour, or replacing >50% of blood volume within 3 hours

Ongoing severe haemorrhage with haemodynamic instability, regardless of exact unit count

Core Principles

Transfuse in a balanced ratio — PRBC : FFP : platelets, roughly 1:1:1 — rather than red cells alone

Correct fibrinogen with cryoprecipitate if it falls below the pregnancy-adjusted target

Give tranexamic acid early — benefit is time-dependent (see our Hemorrhagic Shock guide for the 3-hour window)

Limit plain crystalloid — over-resuscitating with fluid dilutes clotting factors and worsens coagulopathy

🧪 CROSS-MATCHING & COMPATIBILITY

Type & screen: identifies blood group and checks for antibodies — fast, doesn't reserve specific units

Type & crossmatch: full compatibility testing against reserved units — more thorough, but typically takes 30–45 minutes

Emergency uncrossmatched O-negative blood: used when there's no time to wait; switch to crossmatched blood as soon as it's available

Rh-negative woman given Rh-positive blood in an emergency: notify the blood bank and give an appropriate dose of anti-D afterward — this is a bigger dose than routine prophylaxis and should be calculated with transfusion medicine input.

🚨 RECOGNIZE A TRANSFUSION REACTION

Fever, chills, back pain, or dark urine → possible acute haemolytic reaction

Hives, itching, or wheeze → allergic reaction, possible anaphylaxis

Sudden breathlessness or hypoxia within 6 hours → possible TRALI (transfusion-related acute lung injury)

Breathlessness, hypertension, signs of fluid overload → possible TACO (transfusion-associated circulatory overload)

⚠️ WATCH FOR DURING MASSIVE TRANSFUSION

1

Hypothermia — actively warm all fluids and blood products

2

Hypocalcaemia — from citrate in stored blood; check and correct calcium

3

Hyperkalaemia — from stored red cells, especially with rapid large-volume transfusion

4

Dilutional coagulopathy — if PRBC is given without matching FFP/platelets

Rh-Negative Women

Give Rh-negative blood whenever possible

If Rh-positive blood is unavoidable in an emergency, arrange anti-D afterward

Antenatal Anaemia

Prioritize iron correction when time allows

Reserve transfusion for severe, symptomatic, or acute-loss cases

Declining Blood Products

Discuss alternatives early — cell salvage, iron, tranexamic acid, meticulous surgical haemostasis

Document wishes clearly; involve institutional ethics support as needed

After Major Transfusion

Recheck hemoglobin before discharge

Continue iron supplementation postpartum

First Response

Stop The Transfusion

Whatever the suspected reaction, this is always the first move. Stopping immediately limits how much incompatible or reactive blood the patient receives — it gives every other intervention room to work.

Stop the transfusion and disconnect the blood bag, keeping the IV line open with plain saline

Recheck patient identity and unit labels immediately — a mismatch is the single most common cause of acute haemolytic reactions

Notify the blood bank right away; send the remaining unit and a fresh patient blood sample for workup

Treat symptomatically while investigating — oxygen, fluids, antihistamines or steroids for allergic reactions, escalate urgently for anaphylaxis or instability

Reminder: most severe reactions are preventable with correct patient and unit identification — not exotic testing.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary for structured teaching and triage; transfusion thresholds, ratios, and reaction-management steps vary by institution — follow local blood bank and transfusion medicine protocol.