Obstetrical Medical Device for Autotransfusion Following Life Threatening Postpartum Hemorrhage in Low-Resource Settings

Abstract

Due to lack of safe blood supplies and other medical resources, women in low-resource areas are at a higher risk of complications from postpartum hemorrhage (PPH), a leading cause of maternal mortality. Current strategies to treat postpartum hemorrhage are only able to stop the bleeding, not replace the blood volume lost. A team at Brigham and Women’s Hospital is creating a device for autotransfusion that would address these concerns but must integrate multiple different components to make the device feasible. In this integration, the device needs to collect blood and filter out bacterial content while preventing clotting in the system and maintaining an adequate flow rate. To achieve this, a mannose-binding lectin filter must be added to a previous device configuration of leukocyte-depletion filters. A full system integration is difficult to test given the requirements for device construction in a sterile environment and gaining access to human blood, so configurations using a buffer analogue were used to optimize the system in a lab setting. A flow rate of 75 mL/min was achieved in lab settings with E. Coli-spiked TBS-Tween20, and a maximal bacterial reduction of 77.15% ± 3.32% was seen after filtering 20 mL, dropped to 0% ± 7.22% reduction after filtering 100 mL. No statistical significance was seen between reduction with the mannose-binding lectin filter versus without. In clinical settings with anticoagulated post-delivery blood filtered at 20 mL/min, bacterial reduction varied greatly, from 0% to 99%, by patient and bacterial type, though reduction appeared to increase over volume filtered, a trend opposite those observed in lab settings. While much work remains to fully optimize the device, initial results show great promise toward functionality in low-resource settings.