The Changing Transfusion Practice of Neonatal and Pediatric Surgery

Abstract

The use of erythrocyte transfusions to treat anemia in neonatal and pediatric surgery patients has changed dramatically over the last decade. Recombinant human erythropoietin (rHuEPO) has been shown to decrease transfusion exposure in many disease states in both adults and children. rHuEPO has also been used perioperatively in children. This paper discusses perioperative anemia, the current status of rHuEPO therapy, surgical and non-surgical strategies that minimize blood loss, and transfusion therapy in the pediatric surgical patient. 2 Although few prospective studies have investigated perioperative transfusion criteria, a recent review suggests that a hemoglobin transfusion threshold of 8 g/dL should be used in surgical patients without risk factors for tissue ischemia, and 10 g/dL could be justified in those at risk for ischemia. 3In current surgical practice, very few randomized clinical trials examining transfusion triggers are found. 4 In pediatric surgery patients, even less information about transfusion criteria is known. Severe anemia is seen in prematurity and in several disease processes. rHuEPO has been shown to decrease transfusion exposure in many disease states and has been used in perioperative settings. We will provide an overview of the treatment of the anemias of prematurity, renal failure, and cancer, as children with these problems frequently become surgical patients. Additionally, this review will discuss the prevention and treatment of anemia in children who are surgical patients. Children present with unique problems related to anemia,