title: Transfusion requirements in obstetric patients with placenta accreta.
abstract: BACKGROUND
  Providing transfusion support for patients with placenta accreta is a challenging task. There is no consensus on predelivery transfusion planning for these patients and the prevalence of massive transfusion is unknown. With little published experience, it is difficult to predict blood component usage accurately. Therefore, this retrospective study spanning 14 years quantified blood usage and clinical outcome in a group of patients with placenta accreta.
  
  
  METHODS
  A retrospective medical record review identified 66 patients with placenta accreta who presented for delivery. Data were extracted from the patients' medical records related to patient demographics, pathology diagnosis, blood component usage, operative course, and clinical outcome. Selected variables were analyzed for statistical association with total blood component usage.
  
  
  RESULTS
  The range of blood component usage was 0 to 46 red blood cell (RBC) units, 0 to 48 random-donor platelet unit equivalents, 0 to 64 plasma units, and 0 to 30 cryoprecipitate units. The incidence of transfusion was 95% (mean RBC use, 10 ± 9 units; median, 6.5 units), with 39% of patients requiring 10 or more RBC units and 11% requiring 20 or more RBC units. Blood component use did not differ significantly between the pathology-defined placenta accreta subtypes. Potential clinical laboratory variables that would predict increased blood component use were not identified.
  
  
  CONCLUSIONS
  The delivery of patients with placenta accreta is a high-risk procedure that requires multidisciplinary planning and adequate resources to optimize outcome. Transfusion services should have a protocol for managing these cases that addresses preoperative blood component preparation and intraoperative management, should massive hemorrhage occur.
authors.affiliation: Department of Pathology & Cell Biology and Obstetrics & Gynecology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, New York 10032, USA. bs2277@columbia.edu
authors.forename: Brie
authors.initials: B
authors.lastname: Stotler
authors.forename: Anand
authors.initials: A
authors.lastname: Padmanabhan
authors.forename: Patricia
authors.initials: P
authors.lastname: Devine
authors.forename: Jason
authors.initials: J
authors.lastname: Wright
authors.forename: Steven L
authors.initials: SL
authors.lastname: Spitalnik
authors.forename: Joseph
authors.initials: J
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies