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Question 116
Delivery suite → Haemorrhage
Classification
Question
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A woman with ongoing massive APH remains tachycardic and hypotensive despite initial crystalloid resuscitation. Her first haemoglobin concentration is 112 g/L. What is the most appropriate approach to blood replacement?
Question Stem
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Options
A
A) Withhold blood because haemoglobin exceeds 100 g/L
B
B) Wait until haemoglobin falls below 70 g/L
C
C) Repeat haemoglobin in four hours before deciding
D
D) Give iron intravenously instead of blood components
E
E) Base transfusion on the clinical severity and ongoing haemorrhage rather than the initial haemoglobin alone
Explanation
In active major obstetric haemorrhage, transfusion decisions must be driven primarily by the clinical condition and ongoing blood loss. The initial haemoglobin can remain deceptively normal during acute haemorrhage because haemodilution has not yet occurred. A shocked woman with continuing massive APH therefore requires appropriate blood-component replacement without waiting for an arbitrary haemoglobin threshold. Laboratory results remain important for guiding ongoing component therapy but must not delay life-saving resuscitation.
Option Validity
A) An initially normal haemoglobin does not exclude severe acute blood loss.
B) A fixed haemoglobin threshold should not delay transfusion in active life-threatening haemorrhage.
C) Waiting four hours would dangerously delay resuscitation.
D) Intravenous iron cannot restore circulating volume or oxygen-carrying capacity rapidly enough in massive haemorrhage.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.