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Association between age and blood loss in children undergoing open heart operations
G D Williams1, S L Bratton, E C Riley
1Department of Anesthesiology, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle 98105-0371, USA. jwilli@chmc.org
Insights
Young children undergoing open heart surgery experience more blood loss and require more transfusions. Blood loss and transfusions decrease with age in pediatric patients.
Area of Science:
- Pediatric Cardiac Surgery
- Hematology
- Anesthesiology
Background:
- Young children undergoing open heart surgery are at higher risk for perioperative hemorrhage.
- Previous studies suggest increased risk, but associations between age, blood loss, and transfusions in children remain unclear.
Purpose of the Study:
- To define the associations between patient age, blood loss, and blood product transfusions in pediatric patients undergoing open heart surgery.
Main Methods:
- Collected perioperative blood loss and transfusion data for 414 children undergoing open heart procedures.
- Categorized patients into four age groups: neonates (≤1 month), infants (1-12 months), young children (1-5 years), and older children (>5 years).
Main Results:
- Blood loss and transfusions were inversely related to age, with significant differences between the four age groups.
- Median transfusions within 72 hours: neonates (8 units), infants (6 units), young children (2 units), and older children (0 units).
- Preoperative and intraoperative factors influencing hemostasis also varied significantly by age group.
Conclusions:
- Blood loss and the need for blood product transfusions decrease with increasing age in pediatric cardiac surgery patients.
- Neonates experienced the highest blood loss and received the most donor products per kilogram of body weight compared to other age groups.
Background:
Although recent studies indicated young children are at risk for increased perioperative hemorrhage after open heart operations, the associations between patient age, blood loss and blood product transfusions have not been fully defined in children.
Methods:
Perioperative blood loss and blood product transfusion data were recorded for 414 consecutive children undergoing open heart procedures. The children were in the following age groups: 1 month or younger, group 1; older than 1 month to 12 months, group 2; older than 1 year to 5 years, group 3; and older than 5 years, group 4.
Results:
Postoperative blood loss and blood product transfusions were inversely related to age and differed significantly between the four age groups. Multiple preoperative and intraoperative factors that possibly influence hemostasis also differed significantly between age groups. Median units transfused within 72 hours differed significantly with age (p < 0.0001): group 1, 8 units (range, 1 to 19 units); group 2, 6 units (range, 0 to 21 units); group 3, 2 units (range, 0 to 23 units); and group 4, 0 units (range, 0 to 38 units).
Conclusions:
Blood loss and transfusions vary inversely with age. Per kilogram of body weight, neonates bled more and received more donor products than any other age group.
