Intraoperative pediatric blood transfusion therapy: a review of common issues. Part II: transfusion therapy, special considerations, and reduction of allogenic blood transfusions

Surgical Management of Scoliosis in JehovahÂ’s Witness Patients: One InstitutionÂ’s Experience

“…In our series, only one patient was submitted to this blood conservation technique, in 1995. However, there are risks involving its use, particularly spinal cord ischemia during spinal instrumentation and reduction maneuvers [27,28], especially if combined with hemodilution [26]. In our institution, for all posterior spinal fusions, the blood pressure is lowered to a mean arterial pressure of 60-70 during the dissection portion of the case, then it is gradually increased during spinal instrumentation and the remainder of the procedure.…”

Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

“…A study done on hemodynamically stable, critically ill pediatric patients, the TRIPICU trial, showed no adverse effects when comparing a restrictive transfusion strategy initiated at a hemoglobin level of 7g/dl to a transfusion threshold of 9.5 g/dl (10). A specific anemia threshold would be difficult to use as a trigger for MTP activation in the case of massive hemorrhage, because hemoglobin and hematocrit levels might not reveal significant anemia until the patient had been volume resuscitated, making a precise estimate of lost blood volume difficult to ascertain based on these laboratory tests (3,11).…”

“…Exsanguination, either at the site of the accident, or in hospital, accounts for 45% of all traumatic deaths. Motor vehicle collisions (59% mortality from all accidents in age group [5][6][7][8][9][10][11][12][13][14], pedestrian and bicycle accidents, falls, burns, and physical assault are the most common causes of injury in children (1). Many of injured children will require surgical treatment with involvement of the anesthesiologist.…”

Perioperative problems and treatment of a teenager with a juvenile angiofibroma refusing blood transfusion

“…The lowest acceptable haematocrit = minimum value of the haematocrit that should be safe for the patient; this value must be determined individually for every patient. For healthy children during anaesthesia, the lowest acceptable Htc is between 20 and 24% [1,2]. Expected demand for the transfusion = expected blood loss À tolerable blood loss.…”

“…Infrequent reports from medical literature reveal that children tolerate normovolaemic haemodilution well, but the number of cases described is small. A decrease of haematocrit to 24-20% in the intraoperative period is thought to be safe [1,2,25], but further decrease can cause serious neurological complications.…”