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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.
Anesthesia and Analgesia
|May 1, 1991
Summary
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.