Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver.
BACKGROUND
Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case).


METHODS
UCLA Patients with craniosynostosis from 2003-2005 were divided into 1) the study group (Procrit and Cell Saver) or 2) the control group (n = 79). The study group 1) received recombinant human erythropoietin at 3 weeks, 2 weeks, and 1 week preoperatively and 2) used Cell Saver intraoperatively. Outcomes were based on morbidities and transfusion rate comparisons.


RESULTS
The 2 groups were comparable with regards to age (5.66 and 5.71 months), and operative times (3.11 vs 2.59 hours). In the study group there was a marked increase in preoperative hematocrit (56.2%). The study group had significantly lower transfusions rates (5% vs 100% control group) and lower volumes transfused than in the control group (0.05 pediatric units vs 1.74 pediatric units). Additionally, of the 80% of patients in the study group who received Cell Saver blood at the end of the case, approximately 31% would have needed a transfusion if the recycled blood were unavailable.


CONCLUSIONS
Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.
Krajewski
Kara
K
Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, University of California-Los Angeles, CA 90095, USA.
Ashley
Rebekah K
RK
Pung
Nina
N
Wald
Sam
S
Lazareff
Jorge
J
Kawamoto
Henry K
HK
Bradley
James P
JP
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000379:methods*; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy; D017558:Elective Surgical Procedures; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use*; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous; D007430:Intraoperative Care; D011183:Postoperative Complications; D011292:Premedication; D011994:Recombinant Proteins; D019651:Plastic Surgery Procedures; D013997:Time Factors; D016896:Treatment Outcome
D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa