Is blood transfusion necessary in all patients with disseminated intravascular coagulation associated postpartum hemorrhage?

Objective: The diagnosis of disseminated intravascular coagulation (DIC) in obstetrics is complicated owing to physiological changes, particularly during late pregnancy and the postpartum period. Therefore, a pregnancy-modified DIC score that includes only three components of the International Society on Thrombosis and Hemostasis (ISTH) DIC score has been constructed. Our aim was to determine how many blood-transfused postpartum women actually had the diagnosis of overt DIC according to the modified ISTH score and had the correct indications for blood transfusion.

Methods: We retrospectively analyzed 279 women who had received transfusion of at least two units of blood for postpartum hemorrhage. We used the modified ISTH score for DIC, which is based on platelet count, fibrinogen concentration, and prothrombin time (PT) differences. A total score of 26 points or higher indicated overt DIC, whereas a score lower than 26 points represented nonovert DIC.

Results: According to the modified ISTH score, 100 of the 279 patients (35.8%) had overt DIC, with a median DIC score of 37.0. Thirty-five percent of patients in the overt DIC group and 25.7% in the nonovert DIC group had received more than four units of blood. The levels of PT and activated partial thromboplastin time were higher, and the fibrinogen level was lower in patients with overt DIC.

Conclusions: According to the modified ISTH score, we found that blood transfusion was unnecessary in 179 of the 279 postpartum women (64.1%). If this scoring system is used to determine which patients should be transfused, unnecessary transfusions and their related risks and complications will be prevented.