Abnormal coagulation during pediatric craniofacial surgery.
BACKGROUND
This prospective study of children undergoing major craniofacial surgery was undertaken to determine whether abnormal hemostasis occurred and to characterize any coagulopathy found.


METHODS
Coagulation tests, blood loss and blood product transfusions were recorded perioperatively. Packed red blood cells (PRBC) were transfused to maintain target hematocrit. Patients with blood loss >100 ml/kg (group A, n = 5) were compared to patients with blood loss <100 ml/kg (group B, n = 22) using Mann-Whitney U test (p < 0.05).


RESULTS
Twenty-seven children (age range 2.9--27.9 months) had median total blood loss of 64 ml/kg. At completion of surgery, median coagulation values differed significantly between groups for prothrombin time (A: 16.6 s; B: 13.8 s), partial thromboplastin time (A: 44 s; B: 29 s), thrombin time (A: 28 s; B: 23 s), thromboelastograph reaction time (A: 7 mm; B: 4 mm), prothrombin fragment F1.2 (A: 1.9 nmol/l; B: 3.3 nmol/l) and platelet count (A: 174 K/mm(-3); B: 239 K/mm(-3)). Fibrinolysis was not associated with blood loss. Median units transfused were in group A 3 units and group B 1 unit (p = 0.001). All patients received PRBC transfusions but only group A patients received other blood products (fresh frozen plasma, platelets).


CONCLUSIONS
Children transfused with PRBC during craniosynostosis repair can become coagulopathic from coagulation factor depletion when hemorrhage approaches 1.5 times estimated blood volume.
Williams
G D
GD
Department of Anesthesia, University of Washington, Seattle, WA, USA. jumbo.williams@leland.stanford.edu
Ellenbogen
R G
RG
Gruss
J S
JS
D003398:Craniosynostoses / Q000601:surgery*; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000628:therapy; D011300:Preoperative Care; D011446:Prospective Studies