Intraoperative pediatric blood transfusion therapy: a review of common issues. Part I: hematologic and physiologic differences from adults; metabolic and infectious risks

Abstract

Pediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss > or =one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. This paper is divided into two parts: part 1 presents an overview of the physiologic and hematologic differences between children and adults as well as an overview of the metabolic consequences of blood transfusions, risks of disease transmission, and blood compatibility issues.

Untitled

“…During hemoglobin decrease, neonatal myocardium cannot compensate the reduced O2 carrying capacity by increasing cardiac output. Normal term neonatal hemoglobin levels (14-20g %), respectively, begin to fall in subsequent months [21].…”

Pediatric Perioperative Life Support

“…Lower potassium levels are found in RBC products that have been stored for <1 week. 9 Use of succinylcholine can increase the serum potassium by 0.5 mEq/L or more, which can be significant if the patient already has an elevated serum potassium level (such as from potassium-sparing diuretics or renal failure). Additionally, patients with burns, direct muscle trauma, neurologic disorders involving motor muscle defects, or myopathies that weaken skeletal muscle membranes are at risk of releasing a large load of potassium from rhabdomyolysis after receiving succinylcholine.…”

“…Arrests in the OR Figure 4. Tracing of end-tidal CO 2 (ETCO 2 ) during chest compressions, showing decreasing ETCO 2 levels as rescuer fatigues (arrows 1-8) and sudden increase in ETCO 2 during compression when spontaneous circulation returns (9). Adapted from Kalenda.…”

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.…”