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Reconstituted blood reduces blood donor exposures in children undergoing craniofacial reconstruction surgery
Paul A Stricker1, John E Fiadjoe, Amanda R Davis
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA. strickerp@email.chop.edu
Insights
Prophylactic fresh-frozen plasma (FFP) in reconstituted blood improved coagulation and reduced donor exposures in pediatric craniofacial reconstruction, with no change in drain output.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Craniofacial reconstruction surgery in children often involves significant blood loss.
- A shift in transfusion strategy replaced traditional blood components with donor-matched reconstituted blood for intraoperative replacement.
Purpose of the Study:
- To evaluate the impact of prophylactic fresh-frozen plasma (FFP) administered as reconstituted blood.
- To assess effects on postoperative coagulation, surgical drain output, and blood donor exposure in pediatric craniofacial reconstruction.
Main Methods:
- A prospective registry of pediatric craniofacial surgery cases was queried.
- Data from 46 registry cases were compared to 150 historical control cases.
Main Results:
- The reconstituted blood group showed a median of 2 unique donor exposures versus 3 in the historical group (P=0.004).
- Postoperative coagulation derangements (fibrinogen, PT, aPTT) decreased significantly in the reconstituted blood group (2% vs 24%, P=0.001).
- No significant difference was observed in thrombocytopenia incidence or postoperative surgical drain output.
Conclusions:
- Prophylactic use of FFP as reconstituted blood in pediatric craniofacial reconstruction improves coagulation.
- This strategy also reduces the number of blood donor exposures.
- Postoperative drain output remains unaffected by this transfusion approach.
Objective/Aims:
To assess the effect of prophylactic administration of fresh-frozen plasma (FFP) in the form of reconstituted blood in children undergoing craniofacial reconstruction. The outcomes of interest included immediate postoperative coagulation laboratory test results, postoperative surgical drain output, and the number of unique blood donor exposures incurred.
Background:
We recently changed our intraoperative transfusion strategy in children undergoing craniofacial reconstruction surgery to one in which blood loss is replaced with donor-matched reconstituted blood rather than traditional blood component therapy.
Methods:
We performed a query of our prospective craniofacial surgery perioperative registry for children who underwent fronto-orbital advancement or posterior cranial vault reconstruction. Registry data from this query were compared to data from a historical cohort.
Results:
Data for 46 registry cases were compared to 150 historical cohort cases. The median number of unique donor exposures for the reconstituted blood group was 2 vs 3 in the historical cohort (P=0.004). The reconstituted blood group had a decreased incidence of postoperative derangements in soluble clotting factor tests (fibrinogen, PT, or aPTT; 2% vs 24%, P=0.001), while there was no evidence for a difference in the incidence of thrombocytopenia. There was no evidence for differences in postoperative surgical drain output in the reconstituted blood group and historical cohort over the first 12, 24, and 48 h.
Conclusions:
Prophylactic administration of FFP in the form of donor-matched reconstituted blood in children undergoing craniofacial reconstruction was associated with improved postoperative coagulation parameters, reduced blood donor exposures, and unchanged postoperative surgical drain output.
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