Prenatal ABO/RHD Genotyping: A New Paradigm to Allow for Fresh Whole Blood for Cardiopulmonary Bypass in the Immediate Newborn Period

Abstract

Compared to standard component therapy, fresh whole blood (FWB) offers potential benefits to neonates undergoing cardiopulmonary bypass (CPB) in the context of open cardiac surgery: decreased blood loss and subsequent risk of volume overload, improved coagulation status, higher platelet counts during and following CPB, circumvention of limited vascular access, and significantly reduced donor exposures. Obtaining FWB, however, entails 2–5 days of preparation, which often precludes its availability for neonates requiring CPB in the immediate newborn period. Using a multidisciplinary approach and molecular ABO/RHD genotyping on amniotic fluid, we developed a protocol to allow procurement of FWB for timed delivery followed by open cardiac surgery. Eligible subjects include patients undergoing genetic amniocentesis following the diagnosis of a fetal cardiac anomaly likely to require open surgical repair in the initial days after birth. This protocol has been successfully implemented following prenatal diagnosis of severe fetal cardiac anomalies. Taking advantage of the prenatal time period and the ability to perform fetal blood typing prenatally using molecular genotyping makes possible a new paradigm for the availability of FWB for CPB to improve perioperative, short-term, and long-term outcomes in a population comprised of some of the smallest and sickest patients who will undergo CPB.

New research and changing paradigms of coagulopathy in children after cardiac surgery: A narrative review

“…Additionally, in children with transposition of the great arteries, a major and complex surgical correction is mandatory in the first week of life [4]. Therefore, there is an number of CPB cardiac surgeries, which are usually associated with postoperative bleeding and coagulopathy [6,7]. Unlike adults, the pediatric population has relatively less circulatory blood volume [39].…”

“…In surgical settings, post-CPB bleeding and coagulopathy are the most frequent causes of blood product transfusion. Replacement therapy includes the transfusion of whole blood, red blood cells, coagulation factors, or platelets [6,7].…”

“…CPB and ECMO are usually associated with post-operative bleeding and coagulopathy, which may be attributed to decreased levels of coagulants and as a complication from CHD. Bleeding after CPB usually requires a replacement therapy, including the transfusion of whole blood, red blood cells, coagulation factors, or platelets [6,7].…”