Massive blood transfusion in a post cesarean patient with placenta praevia

Massive blood transfusion is replacement of a patient's total blood volume in less than 24 h, or acute administration of more than half the patient's estimated blood volume per hour. This case report describes the clinical profile, laboratory parameters and management of a post operative patient who lost nearly double her blood volume in 36 h. A 27 yr old Indian woman with no history of any medical illness, or co-morbidities underwent elective cesarean section for placenta praevia totalis. The maximal allowable blood loss calculated for her weight with target haemoglobin of 10 g % was 450 ml. Though adequate haemostasis was achieved before closure, she had significantly increased bleeding PV 1 h post-operatively. Over the next 24 h she underwent a subtotal and then a total hysterectomy. Blood loss within this period amounted to 6500 ml. The following day she lost 1900 ml blood through the drains. As is the approach to a surgical patient with massive blood loss, it was ensured that the surgical cause of bleeding is controlled with simultaneous blood component therapy so as to maintain haemostasis, blood oxygen carrying capacity, oncotic pressure and plasma biochemistry. The patient received a total of 18 units Packed Red Blood Cells, 20 units Fresh Frozen Plasma and six platelets over 36 h. The patient showed good recovery. Key points in therapy include control and management of underlying cause, supportive treatment with appropriate blood components for maintaining tissue perfusion and oxygenation.