Blood Components Utilization in Pediatric Cardiac Surgeries at a Tertiary-Care Pediatric Hospital in India

There is a growing interest in pre-operative optimization and decreasing intra/post-operative allogeneic transfusion requirements in cardiac surgeries. This is a retrospective analysis of blood component utilization in pediatric cardiac surgeries at a newly established pediatric cardiac surgery department at a free-standing tertiary care pediatric hospital in India. All pediatric (less than 18 years) cardiac surgery cases between 2018 and 2021 were included. Demographic description, primary diagnosis, type of surgery, estimated total blood loss, total blood utilization for the entire hospitalization since the surgery, blood components transfused, length of hospital stay and mortality were captured. A total of 101 pediatric cardiac surgeries (M:F = 61:40); age distribution: < 1-year 25.7% (26/101), 1-5 years 38% (39/101) and 35.6% > 5 years (36/101) were included. Of these, 83.1% (84/101) were open-heart surgeries [acyanotic CHDs (n = 46); cyanotic CHDs (n = 34) and acquired CHDs (n = 4)] and 16.8% (17/101) were closed-heart surgeries. Of the 101 surgeries, 6 did not need any transfusions. The remaining 95 surgeries utilized a total of 700 units of blood components (mean 7.3 ± 5.3 units/surgery); with a significantly higher number of transfusions in open-heart pediatric surgeries (total 677 units; mean 8 ± 5.2units) as compared to closed-heart surgeries(total 23 units, 1.3 ± 1.5 units) p-value < 0.0001. Blood utilization was significantly higher during the post-operative phase (85.8% of all usage; 601/700 units; mean 5.3 ± 5.9 units per surgery) than intra-operatively (0.9 ± 1 units/surgery), p < 0.01 and in patients who died (n = 27); total 439 units (mean 9.6 ± 8units/surgery) as compared to non-deceased patients (5.9 ± 3.7 units/surgery). In this single institutional experience, the transfusion requirement varied depending on the underlying CHD physiology, and a significant difference seen in transfusion requirements during different phases of the surgery (Intra versus post-operative) and based on survival outcomes of the surgery.