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Published on: May 29, 2021
Massive blood transfusion in choroid plexus tumor surgery: 10-years' experience
Marco Piastra1, Concezio Di Rocco, Alessia Tempera
1Pediatric Intensive Care Unit, Catholic University School of Medicine, Gemelli Hospital, 00168 Rome, Italy. marco.piastra@fastwebnet.it
Insights
Infants undergoing choroid plexus tumor (CPT) surgery experience significantly greater blood loss and coagulation issues compared to older children. Neonatal patients face the highest risks, necessitating careful perioperative management.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Hematology
Background:
- Choroid plexus tumors (CPTs) are rare pediatric neoplasms.
- Surgical management of CPTs can involve significant blood loss, particularly in infants.
- Understanding perioperative risks is crucial for optimizing outcomes in young patients.
Purpose of the Study:
- To evaluate the 10-year surgical experience with childhood choroid plexus tumors.
- To compare perioperative blood loss and coagulation parameters in infants versus older children undergoing CPT surgery.
Main Methods:
- Retrospective chart analysis of 18 pediatric patients with CPTs (1995-2004).
- Measurement of perioperative hematologic and coagulation data.
- Estimation of red cell volume variations as an index of blood loss.
Main Results:
- Infants (<12 months) showed significantly higher blood loss (estimated red cell volume loss: 1.31-1.50%) compared to older children (0.20-0.29%).
- Platelet count decreased more significantly in younger patients (51.60% vs 27.57%).
- Neonatal CPT surgery patients exhibited the most substantial blood loss and coagulation impairment.
Conclusions:
- Younger patients, especially infants, undergoing CPT surgery face elevated risks of massive bleeding.
- Hemodynamic instability and coagulative impairment are significant concerns in this pediatric population.
- Risk stratification and tailored management are essential for improving surgical outcomes in infants with CPTs.
Study Objective:
To describe our 10 years of experience with childhood choroid plexus tumors (CPTs).
Design:
Retrospective chart analysis.
Setting:
Operating room and pediatric intensive care unit (PICU) of a university hospital.
Patients:
18 infants and children undergoing CPT surgery from 1995 to 2004, 11 of whom were younger than 12 months.
Measurements:
Perioperative hematologic and coagulation data were measured as well as estimated red cell volume variations (as a reliable index of blood loss) in the perioperative period, together with coagulation parameters.
Results:
Greater blood loss was recorded in the infant group vs older children (percentage of estimated red cell volume loss, 1.31 +/- 1.79% vs 0.20 +/- 0.17% [P < 0.01] and 1.50 +/- 1.86% vs 0.29 +/- 0.21% [P < 0.01] on PICU admission and after 72 hours, respectively). Platelet count decrease was similarly noted (51.60 +/- 28.06 vs 27.57 +/- 11.98, P < 0.05, as percentage of preoperative count). Patients operated on in the neonatal period showed the highest blood loss and related coagulation impairment.
Conclusion:
Younger CPT surgery patients present an increased risk versus their older counterparts of massive bleeding resulting in hemodynamic instability and coagulative impairment.
