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Foreign. Prior to the 1970s, when component therapy became the preferred method of resuscitation, it was all about whole blood. Whole blood was a resuscitative medium of choice for hemorrhagic shock. Well, sometimes in modern medicine, it turns out that doing things the old way is. Is actually better than the new way. This issue of this was our Intro back on August 2024. A year ago, guys. The exact date was August 9, 2024. Now, the title of that episode whose intro you just heard was, quote, the Return to Low Tighter O Whole Blood for OB Transfusion. End quote. Now, we're not going to go through all the specifics. You can go back and listen to that one from August 9, 2024. We'll put the link in our show. We bring that up for two main reasons. Number one, things tend to gain momentum in print. So something comes out, somebody else put something out. Because good ideas breeds good ideas, and that's good. We should do that as we build momentum for a certain genre of evidence and or theme. And that leads us to our second thing. Our commitment on the show, of course, is to highlight things that are brand new in print. And we're going to do that. There's a brand new publication out of O and G, that is Obstetrics of Gynecology. That's the open version, the free version of the Green Journal O N G that actually comes out of my alma mater. This comes out of UT Southwestern and Parkland. Exactly. Covering and proving what we talked about one year ago on August 9, 2024. Now, Texas really has been leading some of this charge here because back in 2017, an advisory committee, both together with Emergency Medical services and the trauma divisions of our major universities got together and said, you know what? We really need to do this differently. We need to return to whole blood for trauma resuscitation. And then that spilled over then to OB resuscitation for postpartum hemorrhage. Now, the original protocol was low titer, O type, RHD positive. Now, I know what you're thinking, and we covered this in that episode. I'm not going to rehash all that, but you got to go back and listen to that. We're giving people rhd. What if they're RH negative? I get that. Totally true. You can give them rhogam. Because the important thing is, what is more important? That we not sensitize them. Yeah, that's important. Or how about that they not die. Okay, I choose not dying. So that's the purpose here. Even if Somebody is RHD negative. The original protocol was give them low titer O type RHD positive blood because the vast majority of the population, guys is RHD positive. The vast majority of the population is RHD positive. Although there is some ethnic racial differences in blood type. As a whole, more people are gonna be RHD positive than negative. And should your patient be RHD negative then great. If you have the time, do a proper cross match, do type specific RHD negative blood in those. But if you don't have time for that and somebody's hemorrhaging to death, give them low titer, type O, RHD positive and then we'll worry about the rest later and. Or give them rhogam. That is a proposal that we covered one year ago and we talked about all that data of how that had spilled over into ob, postpartum hemorrhage control, the return to whole blood. Now when I trained at Southwestern, that was the thing. I mean nobody got compartment therapy in. It was whole blood because what patients bleed at time of postpartum hemorrhage isn't red blood cells, isn't just platelets, it's entire blood. So give them back what they have lost. Well, there's new data building on this that just came out a few days ago from when we were recording this. And we're at the end of October 2025 and we're going to highlight this from David Nelson and the group. Nelson, great guy, very, very hard worker, great research, author, pillar in mfm. So good for David for putting this together. We're going to cover this. I just came out a couple of days ago out of UT Southwestern, my alma mater, very proud of that and Parkland Hospital. But just goes to show guys that there's, there's momentum here that builds and this is not new. We've covered this a year ago and we advocated. Talk to your unit next time that you do policy and procedures about the possibility of returning to whole blood for postpartum hemorrhage management and especially in labor and delivery, the use of type O negative whole blood because the value seems to be there. Again, we're going to quickly, we're going to go over the small number of N in this study. Small N, it wasn't an rct, it was observational but a prospective study. So very good. Which builds on the data that we covered August 9, 2024. So this is now part two, I guess a year later of what this was covered, of what we discussed one year ago. So fascinating. I really think this is a Big deal. Definitely talk to your units about the possibility of doing whole blood for PPH resuscitation. Listen, component therapy is never gonna go away. It's never gonna go away. Some people just need platelets, in other words, like for ITP or TTP or whatever. Sometimes you just need platelets, sometimes you just need fibrinogen and you need cryo for that. But in a massive hemorrhage state where the patient is otherwise euvolemic and then goes into hypovolemic shock, whole blood is the trick. We're briefly going to touch on ACOG's practice bulletin, which is 183. ACOG's practice bulletin 183. And cover some key specifics here. To act fast, you've got to act fast and get on top of postpartum hemorrhage and do not wait for vital signs to be unstable. And I hear this a lot, especially every to August when we get new team members on board. Those are called interns. They're like, well, she bled, she bled a lot, but her vitals are fine. Don't wait for the vitals. You have to lose like 15 to 20% of blood volume before your vitals kick in. And now thankfully, and that's a good thing. Could you imagine if we lost 10 MLS and we got reflex tachycardia? I mean we would never. That'd be not functionable. So the body has a normal set mechanism to go. I'm gonna give you time, I'm gonna let you do what you do. You can bleed a little bit, you can bleed a little bit. Once you hit 15 to 20, I'm gon start kicking up the gears to get blood flow going to where it needs to go, mainly heart, kidneys, brain, heart, kidney, brain. Not necessarily in that order because we need to increase pulse so that, that, that reflex tachycardia happens around 15 to 20% so it's a relatively later finding. Do not wait for vital signs to tell you that you need blood. I think we covered this last year. Same thing with thirst. If you wait to get thirsty, you are already behind because thirst is a in the dehydration schema cascade. All right, so briefly, briefly, just mention we'll get into practice bulletin 183 just to highlight a few things there and then we'll get into this new publication out of O and G open that just came out a few days ago. I think I've set it up enough. Now let's get into the ins and outs, if you will, of whole Blood. We'll be right back. Can I take your order? Can I get a tall Chai, a large black coffee. A what? Large black coffee. Do you mean a Venti? No, I mean a large. He means a Venti. Yeah, the biggest one you got. Venti is large. No, Venti is 20. Danny. Yeah, large is large. In fact, tall is large and grande is Spanish for large. Venti's the only one that doesn't mean large. He's also the only one that's Italian. So now you can skip all of the coffee shop etiquette or pseudo etiquette and make your great tasting coffee at home. We're thankful for our partnership with the Strong Coffee company that is striving to reach our natural greatness, which is not your ordinary cup of coffee. It has adaptogens, collagen and nootropics to help you reach your maximum potential without the caffeine crash. So thank you to the strong coffee company for your partnership. 20% discount with the link only in our show notes. That is 20% off whatever you buy online so that you can make your own grande Venti large at home. Thank you for the Strong Coffee company, for your partnership. This is Dr. Chapa's OBGYN N no Spin podcast. Right before we left the intro, I said, let's get into the ins and outs of blood transfusion or blood therapy for pph. And it reminded me of an old school movie. Y' all don't know what I'm talking about. Come on now. It was based on Latino kind of, you know, gang life, but not gang life or wannabe gang life, I guess I should say out of kind of like east la. Man, you all don't know about Blood In Blood out, do you? Super melodramatic. It's actually a really good movie. A lot. Launched a lot of careers. Blood In, Blood Out.