🧵 Tranexamic Acid (TXA) in Pregnancy & Delivery – Hematology Scenarios for Fellows ⸻ 💊 Standard PPH Dose •1 g IV over 10 min within 3 hrs of delivery •Repeat 1 g IV after 30 min if bleeding persists or restarts <24 hrs •Max 2 g/24 hrs 📖 WOMAN Trial, Lancet 2017 ⸻ 🧬 Scenario 1 – Immune Thrombocytopenia (ITP) •Use: Adjunct if significant mucosal bleeding at delivery or postpartum •Precaution: Combine with IVIG/steroids/platelets if counts <50k •Pearl: TXA does not increase platelet count → only stabilizes clots 📖 Fogerty AE, ASH Educ Program 2024 ⸻ 🧬 Scenario 2 – von Willebrand Disease (vWD) •Use: Prevent PPH, especially type 1 & 2 with low FVIII/vWF postpartum •Dose: 1 g IV q8h × 48–72 hrs postpartum OR oral TXA 1–1.5 g TID × 7–10 days •Combine with: DDAVP (if responsive) or vWF concentrate 📖 ASH/ISTH/NHF/WFH Guidelines, 2021 ⸻ 🧬 Scenario 3 – Hemophilia Carriers (A or B) •Risk: Low FVIII/IX levels at term → ↑ risk PPH •Use: TXA post-delivery to reduce mucosal bleeding, especially after C-section or lacerations •Pearl: Always measure factor levels at 3rd trimester → replace with factor concentrate if <50% 📖 Srivastava A, Haemophilia 2020 (WFH Guidelines) ⸻ 🧬 Scenario 4 – Inherited Platelet Function Disorders (e.g., Glanzmann thrombasthenia) •Use: TXA reduces mucosal & surgical bleeding postpartum •Combine with: Platelet transfusion or rFVIIa if refractory •Pearl: TXA especially valuable in uterine bleeding due to antifibrinolytic effect 📖 WFH Guidelines 2020 ⸻ ⚠️ General Precautions in Hematology Pregnancies •🚫 Avoid in active VTE or renal failure •🧾 Adjust dose in CKD (renally cleared) •💉 Administer slow IV to prevent hypotension •✅ Compatible with breastfeeding (minimal transfer) ⸻ 📝 Exam Pearls (OSCE/MCQ) MCQ: Which is true about TXA use in PPH? A. Contraindicated if given <3 hrs post-delivery B. First-line before uterotonics C. Reduces maternal death from bleeding if given early ✅ D. Increases VTE risk significantly ➡️ Answer: C OSCE Example: •29F, ITP, platelets 32k at term, presents with heavy postpartum bleeding •Actions: Platelet transfusion + IVIG + TXA 1 g IV over 10 min •Precaution: Avoid NSAIDs/aspirin, monitor for clots ⸻ 📖 References •WOMAN Trial, Lancet 2017 •WHO Recommendations on PPH, 2018 •Fogerty AE, ASH Educ Program 2024 (ITP in pregnancy) •ASH/ISTH/NHF/WFH vWD Guidelines, Blood Adv 2021 •WFH Guidelines for Inherited Bleeding Disorders, Haemophilia 2020 #Hematology #TXA #PPH #ITP #vWD #Hemophilia