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Abnormal coagulation during pediatric craniofacial surgery.

G D Williams1, R G Ellenbogen, J S Gruss

  • 1Department of Anesthesia, University of Washington, Seattle, WA, USA. jumbo.williams@leland.stanford.edu

Pediatric Neurosurgery
|August 8, 2001
PubMed
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Children undergoing major craniofacial surgery can develop coagulopathy due to coagulation factor depletion. Significant differences in coagulation tests were observed in patients with higher blood loss during craniosynostosis repair.

Area of Science:

  • Pediatric Surgery
  • Hematology
  • Anesthesiology

Background:

  • Major craniofacial surgery in children can lead to significant blood loss.
  • Assessing perioperative hemostasis and coagulopathy is crucial in this patient population.

Purpose of the Study:

  • To determine the occurrence of abnormal hemostasis in children undergoing major craniofacial surgery.
  • To characterize the nature of any coagulopathy identified.

Main Methods:

  • Prospective study recording coagulation tests, blood loss, and transfusions.
  • Comparison of patients with blood loss >100 ml/kg (Group A) versus <100 ml/kg (Group B).
  • Statistical analysis using Mann-Whitney U test (p < 0.05).

Main Results:

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  • Median blood loss was 64 ml/kg in 27 children (age 2.9-27.9 months).
  • Significant differences in prothrombin time, partial thromboplastin time, thrombin time, thromboelastograph reaction time, prothrombin fragment F1.2, and platelet count between groups.
  • Higher blood loss group (A) received more blood products, including fresh frozen plasma and platelets.

Conclusions:

  • Coagulopathy can develop in children undergoing craniosynostosis repair due to coagulation factor depletion.
  • Hemorrhage approaching 1.5 times estimated blood volume is a critical threshold for coagulopathy.