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Nineteen years of experience with autotransfusion for elective surgery in children: more troublesome than we expected
Tetsunori Tasaki1, Hitoshi Ohto
1Department of Laboratory Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka City, Iwate 020-8505, Japan. ttasaki@jikei.ac.jp
Insights
Pediatric autologous blood donation poses risks, with 17.3% of child donors experiencing issues like vasovagal reactions. Aggressive donation strategies should be avoided to ensure children's safety in blood donation programs.
Area of Science:
- Pediatric Transfusion Medicine
- Blood Donor Safety
- Surgical Patient Management
Background:
- Autologous blood donation in children undergoing elective surgery is often pursued due to their long life expectancy.
- However, this practice carries potential risks and complications, contrasting with the low risks associated with homologous blood transfusions.
- Previous reports have documented issues arising from aggressive donation protocols, even in infants.
Purpose of the Study:
- To assess the safety and complication rates of autologous blood donation in pediatric patients.
- To evaluate the incidence of donation-related problems in children compared to adults.
- To provide recommendations for safer pediatric autologous blood donation programs.
Main Methods:
- A retrospective study involving 314 children under 16 years old who underwent autologous blood donation assessments between 1987 and 2005.
- Data were collected from blood transfusion services at two Japanese university hospitals.
- Follow-up extended over a 19-year period to track donation-related problems.
Main Results:
- Seven children (2.2%) were unsuitable as donors, primarily due to uncooperative behavior.
- A significant rate of 17.3% of children experienced donation-related problems, higher than the 6% rate in adult donors.
- Nine children suffered severe complications, including vasovagal reactions, with one requiring vasopressor medication.
Conclusions:
- Pediatric autologous blood donation can lead to significant complications, including hypotension in 17% of cases.
- While advanced devices have improved the procedure, managing children's anxiety and tension is crucial for safety.
- Aggressive donation practices in pediatric autologous blood donation programs should be discouraged.
Background:
Under the rationale that children undergoing elective surgery are the best candidates for autologous blood donors because of their long life expectancy, aggressive donations of autologous blood, even from infants, have been reported. A number of problems are associated with the procedure, however, whereas the risks of homologous blood are very low.
Study Design And Methods:
From 1987 through 2005, of 5792 patients referred to blood transfusion services at two Japanese university hospitals for autologous blood donations, 314 children younger than 16 years old served as subjects for assessment.
Results:
Of 314 children, 7 were not suitable as autologous donors. In most cases this was due to uncooperative behavior. Over a follow-up period of 19 years, the authors encountered 53 cases (17.3%) of donation-related problems, and this rate was higher than the 6 percent rate recorded for adult cases (316/5305). Nine children suffered crucial complications such as vasovagal reactions, and one 14-year-old boy required a vasopressor drug. Important findings were that 6 of these were first-time donors, and the amount of blood drawn was under 10 percent of their estimated blood volume.
Conclusion:
Of 53 donation-related problems, 9 (17.0%) were accompanied by marked hypotension. Drawing autologous blood from children has become easier with advanced devices; however, lessening of anxiety and tension are essential for the safety of children's autologous blood donation programs. Aggressive donation should be avoided.
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