Autotransfusion and blood-sparing techniques in infants and children

While several techniques to reduce perioperative blood loss have been established for surgery in adults, not all of them are applicable in paediatric surgery. Further, far less is known about the efficacy of these techniques in this specific population. Consequently, techniques for the prevention of blood loss are often neglected. However, it is these young patients, with their remaining life expectancy, who will benefit the most from any prevented infection (HIV, hepatitis, etc.) or from any immunological complications. Hemodilution is limited because of the high percentage of fetal hemoglobin in small infants, as well as the additional anaesthetic needed to obtain blood. Until recently, intraoperative autotransfusion was ineffective in small children due to technical limitations; however, advanced technology now renders intraoperative autotransfusion possible, even in infants weighing less than 20 kg.