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Hemodilution during bone marrow harvesting in children
V Perez de Sá1, A N Békássy, H Schou
1Department of Anesthesia and Intensive Care, University Hospital, Lund, Sweden.
Insights
Hypervolemic hemodilution using dextran solution in pediatric bone marrow harvesting safely managed hematocrit levels and maintained stable vital signs, allowing procedures without heparinization.
Area of Science:
- Pediatric Anesthesiology
- Hematology
- Oncology
Background:
- Bone marrow harvesting is a critical procedure in pediatric oncology.
- Managing hemodynamics and hematological parameters during harvesting is essential for patient safety.
Purpose of the Study:
- To evaluate the safety and efficacy of hypervolemic hemodilution with dextran in pediatric bone marrow harvesting.
- To assess the impact of this technique on hematocrit, oxygen saturation, and hemodynamic parameters.
Main Methods:
- Eight pediatric patients (1-17 years) with hematological malignancies underwent bone marrow harvesting.
- Preoperative administration of 6% high-molecular dextran solution for hypervolemic hemodilution.
- Monitoring of hematocrit, central venous oxygen saturation (ScvO2), heart rate, and cardiac output.
- Transfusion of packed red blood cells post-harvesting.
Main Results:
- Dextran infusion significantly reduced hematocrit pre-procedure (32% to 28%) and post-aspiration (28% to 18%).
- Central venous oxygen saturation decreased but remained adequate (79% to 70%), correlating strongly with hematocrit (r=0.99).
- Cardiac output increased by 30% during harvesting; heart rate decreased, and arterial pressure remained stable.
Conclusions:
- Hypervolemic hemodilution with dextran is a safe and effective method for pediatric bone marrow harvesting.
- This technique allows for procedures without systemic heparinization while maintaining adequate oxygen delivery.
- Close monitoring of hematocrit and ScvO2 is crucial during this procedure.
Abstract:
Eight children (1-17 yr) underwent bone marrow harvesting while in cytostatic-induced remission of their disease (leukemia [n = 6], Ewing sarcoma, and non-Hodgkin lymphoma). After the induction of general anesthesia, all patients were loaded with 10 mL/kg of a 6% high-molecular dextran solution (Macrodex--Pharmacia), which resulted in a significant preoperative decrease in hematocrit (Hct) from 32% +/- 6% to 28% +/- 5% (hypervolemic hemodilution) and also allowed the procedure to be performed without systemic heparinization. The blood aspirated during the harvest (24 +/- 6 mL/kg; mean +/- SD) was replaced with a solution of 6% dextran and Ringer's acetate solution, and the Hct decreased from 28% +/- 5% to a minimum of 18% +/- 3%. Immediately after the harvest, 10 mL/kg of homologous packed red blood cells was transfused, increasing Hct to 25% +/- 3%. Oxygen saturation in the superior caval vein (ScvO2) decreased from 79% +/- 4% before the harvest to 70% +/- 3% (P less than 0.01) at the end of it, and then increased to 74% +/- 3% after the transfusion of homologous packed red blood cells. There was a strong linear correlation between mean values for Hct and ScvO2 during the various stages (r = 0.99). Mean heart rate decreased gradually during the procedure, from 106 +/- 10 to 86 +/- 7 beats/min. There was no significant change in arterial pressure, but cardiac output measured by impedance cardiography was about 30% greater during harvesting than during undisturbed anesthesia. Pulse oximetric saturation was 99% or 100% throughout. Caval venous blood lactate and pyruvate concentrations remained within normal limits in all children.(ABSTRACT TRUNCATED AT 250 WORDS)