title: Whole Blood in Pediatric Craniofacial Reconstruction Surgery.
abstract: BACKGROUND
  Pediatric complex cranial vault reconstruction (CCVR) surgery is often associated with significant blood loss and transfusion. The authors recently changed our transfusion practice during CCVR to using whole blood (WB) instead of reconstituted blood (RB). The aim of this study was to assess the impact of this practice change. Our hypothesis was that replacement with WB would be as effective as RB for the outcomes of total perioperative blood donor exposures (BDEs) and the incidence of laboratory evidence of postoperative coagulopathy.
  
  
  METHODS
  The authors queried the Pediatric Craniofacial Surgery Perioperative Registry for children ages ≤48 months from our institution who underwent CCVR and received either RB or WB. The primary outcomes of total perioperative BDEs and the incidence of laboratory evidence of postoperative coagulopathy were compared between the 2 cohorts.
  
  
  RESULTS
  The query returned 59 subjects in the RB cohort and 52 subjects in the WB cohort. There were no significant differences in demographic variables between the 2 groups. Patients in the WB cohort were more likely to have ≤1 BDEs when compared to the RB cohort (62% versus 39%, respectively, P = 0.02). There was no significant difference in the incidence of postoperative coagulation laboratory test abnormalities between the WB and RB cohorts (0% versus 3.4%, respectively, P = 0.50).
  
  
  CONCLUSIONS
  There was no postoperative coagulopathy in the WB cohort. Whole blood was also associated with significantly fewer perioperative BDEs. Whole blood appears to be as effective as RB for replacement of blood loss in craniofacial surgery.
authors.affiliation: *Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania †Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania ‡Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania §Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Princy
authors.initials: P
authors.lastname: Thottathil
authors.forename: Deborah
authors.initials: D
authors.lastname: Sesok-Pizzini
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
authors.forename: John E
authors.initials: JE
authors.lastname: Fiadjoe
authors.forename: Ariel
authors.initials: A
authors.lastname: Vincent
authors.forename: Paul A
authors.initials: PA
authors.lastname: Stricker
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D001803:Blood Transfusion; D002675:Child, Preschool; D015331:Cohort Studies; D003398:Craniosynostoses / Q000097:blood* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000097:blood; D019651:Plastic Surgery Procedures / Q000379:methods*; D012042:Registries