Is fresh, leucodepleted, whole blood transfusion superior to blood component transfusion in pediatric patients undergoing spinal deformity surgeries? A prospective, randomized study analyzing postoperative serological parameters and clinical recovery

Abstract

Purpose To compare the effectiveness of fresh whole blood (FWB) and blood component transfusion in improving clinical outcome and serological parameters in the early postoperative period following spinal deformity surgery. Methods Patients undergoing major spinal deformity surgeries involving ≥ 6 levels of fusion and expected blood loss ≥ 750 ml between September 2017 and August 2018 were included in the study. The patients were randomized into two groups: FWBG and CG, receiving fresh whole blood and component transfusions, respectively. Results A total of 65 patients with spinal deformities of different etiologies were included. The mean age was 14.0 and 14.9 years in FWB and CG, respectively. All other preoperative parameters were comparable. The mean fusion levels and surgical time were 11.1 and 221.20 min in FWB, as compared with 10.70 and 208.74minutes in CG, respectively. Intraoperative blood losses were 929 ml (FWBG) and 847 ml(CG), and the mean volumes of transfusion were 1.90 (FWBG) and 1.65 units (CG). FWBG was significantly superior to CG in the following clinical and laboratory parameters: duration of oxygen dependence [36.43 (FWBG) vs. 43.45 h (CG); P = 0.0256], mean arterial pH [7.442 (FWBG) vs. 7.394 (CG); p < 0.001], interleukin-6 [30.04 (FWBG) vs. 35.10 (CG); p < 0.019], mean duration of HDU stay [40.6 hours (FWBG) vs 46.51 hours (CG); p = 0.0234] and postoperative facial puffiness [7/30 in FWBG vs. 18/35 (CG) ( P < 0.02)]. Conclusion FWB transfusion can potentially improve the immediate postoperative outcome in patients undergoing major spinal deformity surgeries by reducing the duration of intensive care unit stay and oxygen dependence. The other potential benefits of this practice, based on our study, include a reduced inflammatory response (reduced lactate and IL-6) and postoperative facial puffiness. However, further large-scale validation studies in future are necessary to precisely determine the role of FWB in spine surgeries. Level of evidence II Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Emergency transfusion with whole blood versus packed red blood cells: A study of 1400 patients

“…Both leukoreduced and non-leukoreduced LTOWB and components were used. The maximum storage time of LTOWB was 21 days, with a median (IQR) of 13 (10)(11)(12)(13)(14)(15) days for LTOWB transfused in this study. To limit the volume of incompatible plasma in an effort to avoid significant hemolysis, nongroup O patients in the LTOWB cohort could receive up to 4 units of LTOWB.…”

“…Only a few studies have examined the safety or efficacy of whole blood in non-trauma patients, 11 one of which was in the military setting 12 and one which was specific to pediatric patients with spinal deformities. 13 Notably, all of the studies to date have small sample sizes, limiting the power for interpretation of comparisons. No study has examined the clinical effect of establishing a policy that implements LTOWB as the initial product for all emergency transfusions.…”