A Transfusion Regimen With Same-donor Packed Red Blood Cells Reduces Exposure to Multiple Blood Donors in Craniosynostosis Surgery.
Journal
The Journal of craniofacial surgery
ISSN: 1536-3732
Titre abrégé: J Craniofac Surg
Pays: United States
ID NLM: 9010410
Informations de publication
Date de publication:
06 May 2024
06 May 2024
Historique:
received:
09
01
2024
accepted:
20
02
2024
medline:
6
5
2024
pubmed:
6
5
2024
entrez:
6
5
2024
Statut:
aheadofprint
Résumé
In major craniosynostosis surgery with moderate to severe blood loss, patients may be exposed to multiple donors. We have previously reported a method for reducing donor exposure using mixed pediatric units including plasma. To further reduce donor exposure, we used plasma-free divided pediatric units. The study aimed to investigate the feasibility of the new strategy for reducing donor exposure. This prospective observational study recruited children younger than 1 year who were scheduled for nonsyndromic craniosynostosis surgery. One adult red blood cell unit was divided into 4 equal units on the day before the operation for use intra- or postoperatively. Number of donor exposures, estimated blood loss, crystalloid, colloid, and blood product volumes, and coagulation parameters were evaluated. Nineteen infants were included. The mean estimated blood loss was 19 (3) mL/kg and the transfusion volume was 17 (7) mL/kg. The median donor exposure per patient was 1 (range, 1-3). During surgery, all infants received at least one DPU. Two infants received transfusions from more than one donor during the intraoperative period. In the first 24 hours postoperatively, 14 infants received transfusion; 10 received only DPUs, whereas 4 received from multiple donors. In all, multiple donor exposure was prevented in 14 of 19 infants. Postoperative Pk-INR was 1.33 (0.16); no plasma or platelets were transfused. The plasma-free DPU transfusion protocol may be useful to reduce donor exposure in open craniosynostosis surgery in infants.
Identifiants
pubmed: 38709036
doi: 10.1097/SCS.0000000000010165
pii: 00001665-990000000-01496
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by Mutaz B. Habal, MD.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Kolar JC. An epidemiological study of nonsyndromal craniosynostoses. J Craniofac Surg 2011;22:47–49
Renier D, Lajeunie E, Arnaud E, et al. Management of craniosynostoses. Child Nerv Syst 2000;16:645–658
Tarnow P, Kölby L, Maltese G, et al. Incidence of non-syndromic and syndromic craniosynostosis in Sweden. J Craniofac Surg 2022;33:1517–1520
Stricker PA, Shaw TL, Desouza DG, et al. Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery. Pediatr Anesth 2010;20:150–159
Meyer P, Renier D, Arnaud E, et al. Blood loss during repair of craniosynostosis. Br J Anaesth 1993;71:854–857
Velardi F, Di Chirico A, Di Rocco C, et al. “No Allogeneic Blood Transfusion” protocol for the surgical correction of craniosynostoses. Child Nerv Syst 1998;14:722–731
Coombs DM, Knackstedt R, Patel N. Optimizing blood loss and management in craniosynostosis surgery: a systematic review of outcomes over the last 40 years. Cleft Palate Craniofac J. 2023;60:1632–1644.
Vega RA, Lyon C, Kierce JF, et al. Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol. J Neurosurg Pediatr 2014;14:190–195
Vamvakas EC, Blajchman MA. Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality. Transfus Med Rev 2010;24:77–124
Lavoie J. Blood transfusion risks and alternative strategies in pediatric patients. Pediatr Anesth 2011;21:14–24
Tyrrell CT, Bateman ST. Critically ill children. Pediatr Crit Care Med 2012;13:204–209
Harrison E, Bolton P. Serious hazards of transfusion in children (SHOT). Pediatr Anesth 2011;21:10–13
Mogensen S, Lubenow N, Nilsson P, et al. An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery. Pediatr Anesth 2017;27:711–717
Kearney RA, Rosales JK, Howes WJ. Craniosynostosis: an assessment of blood loss and transfusion practices. Can J Anaesth 1989;36:473–477
Sihler KC, Napolitano LM. Complications of massive transfusion. Chest 2010;137:209–220
Ebrahim Soltani Z, Hanaei S, Dabbagh Ohadi MA, et al. Safety and efficacy of aprotinin versus tranexamic acid for reducing absolute blood loss and transfusion in pediatric patients undergoing craniosynostosis surgery: a randomized, double-blind, three-arm controlled trial. J Neurosurg Pediatr 2022;29:551–559
Haas T, Goobie S, Spielmann N, et al. Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM®-assisted strategy—feasibility and costs. Pediatr Anesth 2014;24:774–780
Haas T, Spielmann N, Restin T, et al. Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: a prospective randomised controlled trial. Br J Anaesth 2015;115:234–243
Stricker PA, Fiadjoe JE, Davis AR, et al. Reconstituted blood reduces blood donor exposures in children undergoing craniofacial reconstruction surgery. Pediatr Anesth 2011;21:54–61
Reddy SK, Volpi-Abadie J, Gordish-Dressman H, et al. Optimizing perioperative red blood cell utilization and wastage in pediatric craniofacial surgery. J Craniofac Surg 2020;31:1743–1746
Arora S, Marwaha N, Dhawan H, et al. Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients. Asian J Transfus Sci 2017;11:124
Eustache G, Riffaud L. Reducing blood loss in pediatric craniosynostosis surgery by use of tranexamic acid. Neurochirurgie 2019;65:302–309
Jain R, Jarosz CR, Myers TF. Decreasing blood donor exposure in the neonates by using dedicated donor transfusions. Transfus Sci 1997;18:199–203
Haas T, Spielmann N, Restin T, et al. Economic aspects of intraoperative coagulation management targeting higher fibrinogen concentrations during major craniosynostosis surgery. Pediatr Anesth 2016;26:77–83
Bonfield CM, Sharma J, Cochrane DD, et al. Minimizing blood transfusions in the surgical correction of craniosynostosis: a 10-year single-center experience. Child Nerv Syst 2016;32:143–151