title: Prophylactic versus reactive transfusion of thawed plasma in patients undergoing surgical repair of craniosynostosis: a randomized clinical trial.
abstract: BACKGROUND
  Surgical repair of craniosynostosis in young children is associated with copious bleeding and often coagulopathy. Typically, a reactive transfusion strategy is used to treat coagulopathy whereby fresh frozen plasma (FFP) is given only after clinical manifestation of clotting abnormality. This prospective, randomized clinical trial was designed to test the hypothesis that prophylactic FFP during craniofacial surgery reduces blood loss and blood transfusion requirements compared to a reactive FFP transfusion strategy.
  
  
  METHODS
  Eighty-one patients less than 2 years of age requiring primary repair of craniosynostosis were randomized to receive FFP using either a prophylactic or reactive strategy. Laboratory values were measured at four standardized time points. The volume of blood products transfused, length of stay in the pediatric intensive care unit (PICU), hospital length of stay, and number of donor exposures were recorded for each patient.
  
  
  RESULTS
  The prophylactic FFP group received a significantly greater average volume of FFP compared to the reactive group (29.7 ml·kg(-1) vs 16.1 ml·kg(-1) ; P < 0.001), which was associated with improvement in coagulation values at multiple time points. However, there was no difference in blood transfusion requirements or blood loss between the two groups. The two transfusion strategies resulted in similar median donor exposures. There was no difference in PICU or hospital length of stay.
  
  
  CONCLUSIONS
  A reactive FFP transfusion strategy required less plasma transfusion and was associated with similar rates of blood loss and PRBC transfusion as prophylactic FFP despite improvement in coagulation values in the prophylactic FFP group.
authors.affiliation: Department of Anesthesiology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pieters
authors.forename: Lisa
authors.initials: L
authors.lastname: Conley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weiford
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hamilton
authors.forename: Brian
authors.initials: B
authors.lastname: Wicklund
authors.forename: Adam
authors.initials: A
authors.lastname: Booser
authors.forename: Adam
authors.initials: A
authors.lastname: Striker
authors.forename: Susan
authors.initials: S
authors.lastname: Whitney
authors.forename: Virender
authors.initials: V
authors.lastname: Singhal
mesh_terms: D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods*; D002648:Child; D003398:Craniosynostoses / Q000601:surgery*; D017707:Erythrocyte Transfusion; D005260:Female; D006487:Hemostasis; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007431:Intraoperative Complications / Q000628:therapy; D007902:Length of Stay; D008297:Male; D016343:Monitoring, Intraoperative; D010949:Plasma; D017713:Platelet Transfusion; D014914:Whole Blood Coagulation Time
keywords: blood component transfusion; blood loss; blood volume; craniosynostosis; fresh frozen plasma; pediatrics