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Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver
Kara Krajewski1, Rebekah K Ashley, Nina Pung
1Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, University of California-Los Angeles, CA 90095, USA.
Insights
This study shows that using recombinant human erythropoietin (Procrit) and Cell Saver significantly reduces blood transfusions in infants undergoing craniosynostosis surgery. This dual therapy optimizes hematocrit and recycles blood, decreasing the need for blood products.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Craniosynostosis surgery in infants often requires significant blood transfusions due to blood loss.
- Optimizing preoperative hematocrit and intraoperative blood salvage are key blood conservation strategies.
Purpose of the Study:
- To evaluate the efficacy of a dual blood conservation strategy using recombinant human erythropoietin (Procrit) and intraoperative Cell Saver in craniosynostosis correction.
- To reduce packed red blood cell transfusion rates in pediatric patients undergoing craniosynostosis repair.
Main Methods:
- A retrospective study comparing patients who received Procrit and Cell Saver (study group) with a control group (n=79).
- Procrit was administered preoperatively at 3, 2, and 1 week intervals.
- Cell Saver was utilized for intraoperative blood recycling.
Main Results:
- The study group demonstrated a significant increase in preoperative hematocrit (56.2%).
- Transfusion rates were markedly lower in the study group (5%) compared to the control group (100%).
- The volume of blood transfused was significantly reduced in the study group (0.05 pediatric units vs. 1.74 pediatric units).
Conclusions:
- The combination of Procrit and Cell Saver is an effective blood-conserving dual therapy for elective craniosynostosis correction.
- This approach significantly decreases transfusion rates and the overall need for blood products in pediatric patients.
- The study highlights the potential to minimize allogeneic blood transfusions in high-risk pediatric surgical procedures.
Background:
Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case).
Methods:
UCLA Patients with craniosynostosis from 2003-2005 were divided into 1) the study group (Procrit and Cell Saver) or 2) the control group (n = 79). The study group 1) received recombinant human erythropoietin at 3 weeks, 2 weeks, and 1 week preoperatively and 2) used Cell Saver intraoperatively. Outcomes were based on morbidities and transfusion rate comparisons.
Results:
The 2 groups were comparable with regards to age (5.66 and 5.71 months), and operative times (3.11 vs 2.59 hours). In the study group there was a marked increase in preoperative hematocrit (56.2%). The study group had significantly lower transfusions rates (5% vs 100% control group) and lower volumes transfused than in the control group (0.05 pediatric units vs 1.74 pediatric units). Additionally, of the 80% of patients in the study group who received Cell Saver blood at the end of the case, approximately 31% would have needed a transfusion if the recycled blood were unavailable.
Conclusion:
Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.
