title: Mediastinal bleeding after cardiopulmonary bypass in pediatric patients.
abstract: BACKGROUND
  The purpose of our review was to develop simple clinical recommendations to reduce the need for allogeneic blood transfusions in children undergoing cardiac operations.
  
  
  METHODS
  The literature on hemostasis as it relates to children, cardiac disease in children, and pediatric heart surgery was reviewed. We also reexamined the efficacy of several strategies in this patient population: on-site monitoring of coagulation, transfusion of fresh whole blood, and administration of desmopressin, epsilon-aminocaproic acid, or aprotinin.
  
  
  RESULTS
  Children with heart disease may present with preoperative thrombocytopenia, reduced platelet aggregation, and a decreased level of von Willebrand factor. Infants less than 6 months of age show a significant dilution of coagulation factors and decreased platelet counts during cardiopulmonary bypass. Fresh whole blood reduces blood loss in children younger than 2 years undergoing complex operations. Desmopressin does not reduce bleeding, whereas on-site monitoring, synthetic antifibrinolytics, and aprotinin require further evaluation in pediatric cardiac surgical patients.
  
  
  CONCLUSIONS
  The use of fresh whole blood to reduce blood loss in children younger than 2 years undergoing complex heart operations is recommended. Therapy for excessive bleeding after cardiopulmonary bypass will vary according to the patient's age, platelet count, and activated partial thromboplastin and prothrombin times.
authors.affiliation: Department of Anesthesia, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Guay
authors.forename: G E
authors.initials: GE
authors.lastname: Rivard
mesh_terms: D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control / Q000628:therapy*