[Blood transfusion in pediatric patients and strategies to decrease it: a reevaluation.]

Several approaches and techniques are used in adult patients to decrease or prevent both blood loss and homologous blood transfusion during surgical procedures where massive blood losses are expected. While these blood-sparing strategies are widely used in adults, they are mostly neglected in children. Perhaps in pediatric patients, these blood-sparing techniques may not be as effective as in adults and technical limitations, as the small size of patients could limit its advantages. In the following review, blood-sparing techniques established for adults are described and their applicability in pediatric patients discussed.

Blood-sparing strategies developed for adult patients aiming at decreasing or even preventing homologous blood transfusion when massive blood losses are expected, are presented through a bibliographic review. Since all known methods were developed for adult patients, an action line was drawn for the reevaluation of these methods, techniques and drugs to be used in pediatric patients.

It has become once more clear that solutions for adult patients may not be as effective for pediatric patients. Intraoperative blood-sparing techniques and consequent decrease in the need for homologous blood are effective for adult patients but are by far more invasive, complicated, and some of them ineffective in pediatric patients, especially those under two years of age.