title: Reduced transfusion requirement with use of fresh whole blood in pediatric cardiac surgical procedures.
abstract: BACKGROUND
  Pediatric patients undergoing cardiac operations are at high risk for blood loss and transfusion. A practice intended to reduce transfusion using a standard order of 2 units fresh whole blood (< 48 hours from donation) for elective cardiac operations in patients younger than 2 years of age was in place from 1995 to 2010. The objective of this study was to describe blood use in this population and to compare the results with those in published reports describing the use of blood components exclusively for transfusion.
  
  
  METHODS
  Retrospective data from a surgical registry and blood bank records for 15 consecutive years were analyzed. Transfusion requirements were identified as donor exposures for the day of operation and the next postoperative day. Transfusions were fresh whole blood, packed red blood cells, platelets, and cryoprecipitate. Donor exposures for subgroups according to procedure and age were compared with those in published reports.
  
  
  RESULTS
  The cohort consisted of 4,111 patients with a median age of 94 days and a median weight of 4.4 kg. The median donor exposure was 2 (range, 0 to 28). Younger patients having complex procedures had the most donor exposures. Fewer donor exposures were incurred in all subgroups compared with reports of component use in the literature.
  
  
  CONCLUSIONS
  The use of fresh whole blood for cardiac operations in children younger than 2 years old reduces donor exposures compared with published reports of component use.
authors.affiliation: Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: jobes@email.chop.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Jobes
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sesok-Pizzini
authors.affiliation: Department of Clinical Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Friedman
mesh_terms: D000367:Age Factors; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D012189:Retrospective Studies