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Question 161
Delivery suite → Haemorrhage
Classification
Question
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A woman with placental abruption has ongoing massive haemorrhage despite red-cell and plasma replacement. She is proceeding to emergency operative delivery. Her platelet count has fallen to 42 × 10⁹/L and diffuse microvascular bleeding is evident. Which blood component most directly addresses the demonstrated cellular haemostatic deficit?
Question Stem
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Options
A
Cryoprecipitate
B
Additional packed red cells
C
Human albumin solution
D
Fresh frozen plasma alone
E
Platelet concentrate
Explanation
In massive obstetric haemorrhage, blood-component therapy should address the specific haemostatic abnormalities that develop. A platelet count of 42 × 10⁹/L with active diffuse bleeding represents clinically important thrombocytopenia, and platelet replacement directly treats that cellular haemostatic deficit. Fresh frozen plasma replaces multiple coagulation factors, while cryoprecipitate is particularly relevant to severe fibrinogen depletion. Red cells restore oxygen-carrying capacity but do not correct thrombocytopenia. Major abruption can produce rapidly evolving consumptive coagulopathy, so component requirements must be reassessed repeatedly.
Option Validity
A) Cryoprecipitate principally addresses severe fibrinogen depletion rather than the demonstrated thrombocytopenia.
B) Packed red cells restore oxygen-carrying capacity but do not correct platelet deficiency.
C) Human albumin solution does not replace platelets or coagulation factors.
D) Fresh frozen plasma provides coagulation factors but does not directly correct a markedly reduced platelet count.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.