Erythropoietin therapy and acute preoperative normovolaemic haemodilution in infants undergoing craniosynostosis surgery.
BACKGROUND
A retrospective study was performed to evaluate whether pretreatment with erythropoietin and iron combined with acute preoperative normovolaemic haemodilution (APNH) could decrease homologous blood transfusion in craniosynostosis (CS) surgery. A treated group was compared with a historical group of infants who underwent surgery with no pretreatment.


METHODS
The charts of 25 healthy infants who underwent CS surgery were reviewed. Nine of them underwent surgery with no treatment beforehand. Sixteen infants were given erythropoietin at a dosage of 300 U.kg -1 two times per week and iron (elemental iron 10 mg.kg-1.day-1) for 3 weeks before surgery. On the day of surgery APNH was performed after induction of general anaesthesia; a precalculated amount of autologous blood was withdrawn and replaced by hydroxyethyl starch 6%.


RESULTS
Eleven of the 16 infants of the study group received only autologous blood. Five of 16 received homologous blood transfusion vs seven of nine infants in the control group.


CONCLUSIONS
APNH combined with erythropoietin was effective in reducing homologous blood requirements during CS surgery. Further studies are necessary on a larger scale to assess the role of this technique in avoiding homologous blood transfusion and to evaluate how infants can benefit from this combined approach.
Meneghini
Luisa
L
Anesthesiology and Intensive Care Institute, Transfusion Medicine and Immune-Hematology and Pediatric Neurosurgery, University of Padua, Italy.
Zadra
Nicola
N
Aneloni
Vittorio
V
Metrangolo
Salvatore
S
Faggin
Roberto
R
Giusti
Franca
F
D000758:Anesthesia; D001803:Blood Transfusion; D003398:Craniosynostoses / Q000601:surgery*; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007223:Infant; D008297:Male; D010952:Plasma Substitutes / Q000627:therapeutic use; D011300:Preoperative Care; D011994:Recombinant Proteins; D012189:Retrospective Studies
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D011994:Recombinant Proteins; D004921:Erythropoietin