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Whole Blood in Pediatric Craniofacial Reconstruction Surgery
Princy Thottathil1, Deborah Sesok-Pizzini, Jesse A Taylor
1*Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania †Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania ‡Department of Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania §Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA.
Using whole blood (WB) in pediatric complex cranial vault reconstruction (CCVR) surgery led to fewer blood donor exposures and no increase in coagulopathy, proving as effective as reconstituted blood (RB). This practice change benefits pediatric craniofacial surgery patients.
Area of Science:
- Pediatric Surgery
- Transfusion Medicine
- Craniofacial Surgery
Background:
- Pediatric complex cranial vault reconstruction (CCVR) involves significant blood loss, often necessitating transfusions.
- A recent shift in transfusion practice involved using whole blood (WB) instead of reconstituted blood (RB) for CCVR.
- The study aimed to evaluate the impact of this transfusion practice change.
Purpose of the Study:
- To assess the effectiveness of whole blood (WB) versus reconstituted blood (RB) in pediatric CCVR.
- To compare total perioperative blood donor exposures (BDEs) between WB and RB groups.
- To evaluate the incidence of laboratory-diagnosed postoperative coagulopathy in both groups.
Main Methods:
- A retrospective review of the Pediatric Craniofacial Surgery Perioperative Registry.
- Inclusion criteria: children aged ≤48 months undergoing CCVR receiving either RB or WB.
- Comparison of primary outcomes: total perioperative BDEs and postoperative coagulopathy incidence.
Main Results:
- The study included 59 patients in the RB cohort and 52 in the WB cohort.
- Patients receiving WB had significantly fewer (≤1) perioperative blood donor exposures (62% vs. 39%, P=.02).
- No significant difference in postoperative coagulopathy was observed between WB and RB groups (0% vs. 3.4%, P=.50).
Conclusions:
- Whole blood transfusion in pediatric CCVR was associated with fewer blood donor exposures.
- No instances of postoperative coagulopathy were noted in the whole blood group.
- Whole blood is as effective as reconstituted blood for managing blood loss in craniofacial surgery.