Minimizing perioperative blood loss and transfusions in children.
OBJECTIVE
To summarize the physiology and pathophysiology relevant to perioperative blood loss in children. Strategies to reduce blood losses are reviewed.


METHODS
The literature was reviewed using the electronic library PUBMED and the Cochrane Database of Systematic Reviews. Relevant studies published in English or French with an English abstract are included. The following keywords were used: children, blood transfusion, surgical blood loss, erythropoietin, autologous blood, red blood cell saver, normovolemic hemodilution, desmopressin, aminocaproic acid, tranexamic acid, aprotinin, cardiac surgery, liver transplantation and scoliosis surgery.


RESULTS
For patients with idiopathic scoliosis, predonation with or without the addition of erythropoietin is a safe and effective way to avoid the use of allogenic blood products. For open heart procedures: whole blood of less than 48 hr is helpful for children of less than two years of age undergoing complex procedures; tranexamic acid may be helpful for cyanotic heart disease and, to a lesser degree, for reoperations; while anti-kallikrein blood levels of aprotinin may both reduce the need for allogenic blood transfusions and improve postoperative oxygenation in infants.


CONCLUSIONS
Reducing perioperative allogenic blood transfusions is possible in pediatric patients provided that prophylactic measures are adapted to age, disease and type of surgery.
Guay
Joanne
J
Department of Anesthesiology, Maisonneuve-Rosemont Hospital, Montreal, Quebec H1T 2M4, Canada. joanne.guay@umontreal.ca
de Moerloose
Philippe
P
Lasne
Dominique
D
D000818:Animals; D001688:Biological Products / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002648:Child; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D019990:Perioperative Care; D012307:Risk Factors; D065227:Transfusion Reaction
D001688:Biological Products