Podcast Summary: "Whole Blood for PPH!"

Dr. Chapa’s OBGYN Clinical Pearls
Date: October 31, 2025
Host: Dr. Chapa

Overview

This episode focuses on the resurgence of whole blood transfusion for postpartum hemorrhage (PPH), highlighting the latest observational data from UT Southwestern and Parkland Hospital. Dr. Chapa, with his signature engaging and conversational style, reviews recent research that builds on evidence he discussed in a previous episode (August 9, 2024). The main thrust: sometimes, time-tested methods (whole blood) may offer advantages over modern component therapy for OB trauma resuscitation.

Key Discussion Points & Insights

1. Whole Blood vs. Component Therapy: Historical Context

• Background:
  • Pre-1970s: Whole blood was the standard for resuscitation in hemorrhagic shock.
  • The shift to component therapy occurred due to supply concerns and the perceived benefits of targeted transfusions.
• Relevance:
  • "Sometimes in modern medicine, it turns out that doing things the old way is actually better than the new way." – Dr. Chapa [00:20]

2. The Texas Leadership & Evolution of Protocols

• Texas’s Role:
  • Since 2017, Texas trauma and OB leaders have advocated revisiting whole blood, first in trauma, then in OB settings.
• Low Titer O RHD Positive Protocol:
  • "Even if Somebody is RHD negative… we're giving people RHD, what if they're RH negative? ... You can give them RhoGam. Because the important thing is...that they not die." – Dr. Chapa [02:10]
  • Emphasis on immediate survival over Rhesus sensitization in acute emergencies.

3. New Evidence from UT Southwestern/Parkland

• Latest Study:
  • Published in Obstetrics & Gynecology Open (ONG Open)
  • Prospective, observational study (not an RCT), Jan 2019–Nov 2023, n=52 vaginal deliveries with PPH requiring transfusion within 2 hours postpartum.
• Key Findings:
  • "Those who initially received whole blood were transfused significantly fewer total blood products overall and required operative procedures less frequently." [16:30]
  • No significant difference in delays from order to transfusion.
  • Less crystalloid fluid used in whole blood recipients.
  • Conclusion: "This study suggests improved clinical outcomes with the use of whole blood. However...additional research is needed before widespread implementation." [17:30]

4. ACOG Practice Bulletin 183: When To Act

• Timing is Critical:
  • Do not wait until unstable vitals; clinical intervention should come before significant vital sign changes.
  • "You have to lose like 15 to 20% of blood volume before your vitals kick in." [08:30]
  • Vitals such as tachycardia are late signs—respond earlier to clinical cues of PPH.

5. Practical Approach to Transfusion in PPH

• Component Therapy – The Old '1:1:1' Rule:
  • 1 packed RBC : 1 FFP : 1 platelets—originated in trauma
• Whole Blood Advantage:
  • For most postpartum hemorrhage, the patient needs “everything.”
  • "If you're doing component therapy...the 1:1:1 isn't for otherwise mild and controlled PPH. This is for massive blood transfusion... or avoid all that nonsense and give a unit of whole blood." [12:20]
• Dr. Chapa’s Principle:
  • “They are not hemorrhaging components. They are hemorrhaging whole blood. So as blood leaves the body, blood should enter the body as a basic principle to keep patients healthy.” [18:45]

6. Cultural References & Personal Touch

• Movie Quotes & Humor:
  • Frequent playful references to the film "Blood In, Blood Out" to emphasize the key message (“If I haven't taught you anything else this episode about the value of whole blood, at least you've learned, chale.” [19:38])
  • Use of Spanish slang (“chale”, “essay”) for camaraderie and a relaxed teaching atmosphere.

Notable Quotes & Memorable Moments

• Life Over Sensitization:
  • “What is more important? That we not sensitize them...Or how about that they not die? Okay, I choose not dying.” – Dr. Chapa [02:15]
• Blood Loss and Vitals:
  • “Do not wait for vital signs to tell you that you need blood...once you hit 15 to 20%, I’m gonna start kicking up the gears...that reflex tachycardia happens around 15 to 20% so it’s a relatively later finding.” – Dr. Chapa [08:35]
• Study Summary:
  • “Those who initially received whole blood were transfused significantly fewer total blood products overall and required operative procedures less frequently.” – Dr. Chapa quoting the new study [16:30]
• Bottom Line:
  • “If they're bleeding whole blood, give whole blood back.” – Dr. Chapa [19:14]
  • “Consider whole blood when possible for postpartum hemorrhage because patients are going to do overall well to slightly better than component therapy.” [17:15]
• Teaching Moment:
  • “If I haven't taught you anything else this episode about the value of whole blood, at least you've learned, Chale.” [19:38]

Timestamps for Important Segments

• 00:00 – 02:30: Intro, prior episode recap, evolution of whole blood resurgence
• 02:30 – 05:30: Texas protocols & rationale for low titer O RHD positive in emergencies
• 08:00 – 10:20: ACOG guidelines, vital signs lag in PPH, “don’t wait for tachycardia”
• 10:44 – 12:30: Trauma, class II/III blood loss, escalation to component/whole blood
• 12:30 – 16:30: Whole blood vs. component therapy, context for massive transfusion
• 16:30 – 18:00: Summary and key findings from the new ONG Open study
• 18:00 – 20:00: Practical takeaways, humor, and repeated “Blood in, blood out” motif

Podcast Takeaways

• Whole blood is a promising option for initial PPH management, possibly reducing the need for total blood products and additional interventions.
• Intervene early—don't wait for vital sign changes. Physical findings and ongoing blood loss matter more than late vital sign changes.
• Component therapy remains important and will not be obsolete, but whole blood may be superior for acute, undifferentiated PPH.
• If unable to precisely type blood in emergencies, low titer O RHD positive is reasonable, and RhoGam can be given later if needed.
• Staying current with emerging evidence can shape and improve OB hemorrhage protocols.
• Above all: “As blood leaves the body, blood should enter the body.”

For medical professionals, students, and teams: Consider discussing the role of whole blood in postpartum hemorrhage at your next policy meeting or journal club, as Dr. Chapa recommends.