management of parturients who decline blood transfusion oaa national survey 122

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.