• Michaela Kristina Farber, Neeti Sadana, Richard Max Kaufman, Xiaoxia Liu, and Bhavani Shankar Kodali.
• Department of Anesthesiology and Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
• Am. J. Obstet. Gynecol. 2014 Apr 1;210(4):323.e1-7.

ObjectiveA 1:1:1 ratio of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT) has been advocated for trauma hemorrhage, but the effectiveness of this ratio for postpartum hemorrhage is unknown. We created an in vitro hemodilutional model to investigate this strategy.Study DesignBlood from 20 parturients at term was diluted 50% with 0.9% normal saline. Diluted samples were reconstituted with 1:1 PRBC:FFP or 3:1 PRBC:FFP. In 10 samples, PLT were also added. Baseline, diluted, and reconstituted sample thromboelastographic values were compared.ResultsMaximum amplitude (MA) was lower compared to baseline values in both groups after 50% dilution with normal saline (P < .001) and remained lower than baseline despite reconstitution with 3:1:0 or 1:1:0 PRBC:FFP:PLT (P < .0001) or 3:1:1 PRBC:FFP:PLT (P < .01). MA approached baseline (P = not significant) in the samples with 1:1:1 PRBC:FFP:PLT.ConclusionThe addition of PLT to 1:1 PRBC:FFP optimized MA in this in vitro hemodilutional model of postpartum hemorrhage.Copyright © 2014 Mosby, Inc. All rights reserved.

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