You receive a page from labour ward.

A woman at 35/40 weeks gestation has just arrived in the hospital very distressed in a lot of pain. A quick bedside ultrasound by the obstetric team has unfortunately demonstrated a large abruption and fetal death in utero. She is contracting strongly and beside herself in pain, the team would like you to come down and place an epidural for analgesia. The team are hoping she will deliver vaginally in the next few hours.

What is your approach in this situation?

Join Graeme and I as we discuss this complex and challenging clinical condition and the coagulopathy that can occasionally occur.

Here is a link to cases we have had in the past here at KEMH in the ROTEM Real Cases Discussed section:

Case 6 – Abruption and fetal death in utero

Case 11 – Abruption and severe coagulopathy

Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy 2015 Liverpool Womens Hospital – this is not open access but available through the ANZCA library or your hospital library. It contains 4 very interesting case reports

Fibrinolytic and thrombotic DIC an explanation 2023 – This paper explains how there are two types of DIC one predominantly causing microvascular thrombosis and eventually factor depletion. The second which is possibly the mechanism seen in some abruptions is massive activation of fibrinolysis and fibrinogenolysis. WARNING this paper is highly technical!

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Hi Everyone,

Whole blood, freeze dried plasma, refrigerated or frozen platelets….

On Oct 31st – Nov 3 Graeme, Emelyn and I attended the THOR – THUNDER conference hosted here in Perth at the Rendezvous Hotel in Scarborough.

Who is THOR? In their own words:

The THOR (trauma haemostasis oxygenation resuscitation) organization is a resuscitation and blood network, originating in Norway a decade ago, and now boasting global reach. It has built an avid following of both civilian and military resuscitation clinicians and scientists, covering both pre-hospital and hospital management of critically unwell patients.

The THOR vision is to improve outcomes from traumatic haemorrhagic shock by optimising the acute phase of resuscitation. The mission is to develop and implement the best practices for haemorrhagic shock resuscitation from pre-hospital care right through to the completion of the acute phase of hospital resuscitation.

Thor group website: Trauma Hemostasis and Oxygenation Research Network (rdcr.org)

We sat down to reflect on the different topics that were presented at this fascinating conference. A big shout out to Tania Rogerson for organising such an amazing bunch of speakers. It was great to hear how resuscitation of major haemorrhage is done in other parts of the globe and to be educated about some different resuscitation products that are not available here in Australia.

If you also want to hear a great deep dive into the scientific evidence base for the management of massive haemorrhage then I highly recommend listening to Casey Parker and Justin Morgenstein discussing this topic here (thanks for a great balanced summary of the evidence):

Massive Haemorrhage: Science and Practice – Broome Docs – Nov 2023

Massive hemorrhage: a very deep dive – First10EM – Nov 2023

Evaluation of freeze dried plasma for use in NSW – https://aci.health.nsw.gov.au/networks/trauma/resources/freeze-dried-plasma

There has even been a pilot study comparing whole blood for use in accrete spectrum surgery in San Antonio:

Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program.J Matern Fetal Neonatal Med 2022 Dec;35(25):6455-6460.

The Use of Whole Blood Transfusion in Trauma – Curr Anesthesiol Rep Jan 2022

Warming Up to Cold-stored Platelets Anesthesiology December 2020, Vol. 133, 1161–1163. 

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Hi everyone,

Welcome to part 3 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia.

These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years!

We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening – thanks Anastazia and Nolan for giving up a few hours to put these together!

The post 121 PBM Case discussion with Anastazia and Nolan part 3 blood is not an option. appeared first on obsgynaecritcare.

Hi everyone,

Welcome to part 2 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia.

These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years!

We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening – thanks Anastazia and Nolan for giving up a few hours to put these together!

The post 120 PBM case discussion with Anastazia and Nolan part 2 postpartum anaemia appeared first on obsgynaecritcare.

Hi everyone,

Welcome to part 1 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia.

These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years!

We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening – thanks Anastazia and Nolan for giving up a few hours to put these together!

Safety of Intravenous Iron Following Infusion Reactions Stojanovic et al The Journal of Allergy and Clinical Immunology: In Practice Volume 9, Issue 4, April 2021: 1660-1666 – A great paper discussing the different types of reactions to i.v. including the Fishbane reaction and how they were managed in over 13000 iron infusions at the Alfred Hospital in Melbourne. Unfortunately it is an Elsevier publication and you will need some sort of institutional access to read it in full.

The post 119 PBM case discussion with Anastazia and Nolan part 1 preop anaemia appeared first on obsgynaecritcare.

Hi Everyone,

This week we are joined by Dr Anastazia Keegan an obstetric haematologist and the head of Haematology at our Women’s hospital here in Western Australia. Join us as Anastazia educates us about congenital bleeding disorders in pregnancy – the common ones, Von Willebrands disease and haemophilia – and how to approach a woman with one of the many uncommon ones (which working in a tertiary referral centre are more common than you would expect).

Thanks for all the great advice and insights – we look forward to having Anastazia back in the near future for the lowdown on some more really important haematological conditions we encounter in women’s health.

Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy. Med J Aust 2019; 210 (7):

Online Bleeding Assessment Tool ISTH-BAT

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A nulliparous woman is admitted to labour ward in established labour, she is in a lot of pain and asks for an epidural. The team note that a full blood count taken 2 days ago showed a platelet count of 48. Is this a real thrombocytopenia? What are the causes of thrombocytopenia in pregnancy? How are they treated? What about epidural or spinal anesthesia? Will she bleed? What if it falls further and she needs platelets?

Hi everyone,

Welcome to part 2 of our discussion on thrombocytopenia and platelets in pregnancy with Dr Simon Kavanagh a consultant haematologist.

As this is a conversation split into two – if you haven’t already please listen to part 1 first (see link below):

Thanks Simon!

The post 087 Thrombocytopenia in pregnancy and platelet transfusions with Dr Simon Kavanagh Part 2 appeared first on obsgynaecritcare.