Preoperative autologous blood donations in pediatric cardiac surgery

Masuda, M; Kawachi, Yosito; Inaba, Shuichi; Matsuzaki, Kyosuke; Fukumura, Fumio; Morita, Shigeki; Tominaga, Ryuji; Yasui, Hirofumi

doi:10.1016/0003-4975(95)00715-6

Cited by 26 publications

(25 citation statements)

References 20 publications

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“…In this study, we included younger patients (4-9 years old: n = 25, 10-17 years old: n = 295) than previous studies [11][12][13][14][15][16]. Some reports did not assess donors under 17 years of age, because they primarily analyzed allogeneic donors [2,4,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Some reports did not assess donors under 17 years of age, because they primarily analyzed allogeneic donors [2,4,6,7]. Previous studies demonstrated the safety of autologous blood donation for pediatric cardiac surgery (n = 80) [13] and homologous donation from high school students [17], and the risk of VVR was reported to be higher in younger autologous or homologous blood donors [2,3,11,15]. Our data revealed that the patients most susceptible to developing VVR were 10-13 years old, followed by those aged 14-17 years.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of vasovagal reactions during preoperative autologous blood donation: a single-institution analysis

Nishimori

Fujii

et al. 2017

Int J Hematol

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Studies examining risk factors associated with vasovagal reactions (VVRs) during autologous blood donations, especially in younger subjects, have been limited. The aim of the present study was to define risk factors for VVRs during preoperative autologous blood donation in patients, including those younger than 18 years old. We retrospectively analyzed 4,192 autologous, preoperative blood donations between 2007 and 2015 at Okayama University Hospital. Eighty-seven (2.08%) of the patients experienced VVRs. VVRs occurred approximately three times as often in patients 0-17 years old (16/320, 5.0%) than in patients 18 years and older (71/3,872, 1.8%). In particular, VVRs occurred more frequently in those 10-13 years old, and decreased with older age (P = 0.006). In a univariate analysis, younger age, lower body mass index, lower systolic blood pressure, lower body weight, lower total blood volume, female gender, first-time collection, and higher heart rate were associated with a higher incidence of VVRs. In a multivariate analysis, lower systolic blood pressure (P < 0.001), higher heart rate (P = 0.007), and first-time collection (P = 0.015), remained independent predictors of VVRs. These results emphasize the need for careful attention during blood collection. Keywords: Autologous blood donation, vasovagal reactions 3 IntroducitonAutologous blood donation is widely used for preoperative blood preparation to reduce exposure to allogeneic blood [1]. Autologous and allogeneic blood donors occasionally experience adverse reactions during or after blood withdrawal, such as weakness, pallor, nausea, sweating, and fainting [2,3]. These symptoms are generally called "vasovagal reactions" (VVRs) [2,4]. However, the pathophysiology of VVRs is not yet completely understood [5]. Although risk factors for VVRs have been analyzed mainly in healthy allogeneic donors or peripheral blood stem cell donors [2,4,[6][7][8], reports describing patients undergoing autologous collection have been limited. In particular, there are few data concerning patients younger than 16-18 years old. In the present study, we analyzed the risk factors for VVRs during autologous donation in patients, including those younger than 18 years old, at a single institution. Materials and methodsWe retrospectively collected medical information from 4,192 patients (groups I + II) who underwent autologous Patients were screened for vital signs, height, body weight, and complete blood count. Enrolled patients underwent whole blood phlebotomy in a designated room: blood volumes did not exceed 400 mL, or [body weight]/50 × 400 mL if the patient's body weight was less than 50 kg. All collections were conducted by a physician and nurse from the Department of Transfusion Medicine at Okayama University Hospital. An 18-gauge needle was inserted into an antecubital vein or a large forearm vein of each patient, and autologous blood was collected using a negative pressure blood drawing device (Hemoquick; Terumo, Tokyo, Japan). After phlebotomy, the patients were adm...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of vasovagal reactions during preoperative autologous blood donation: a single-institution analysis

Nishimori

Fujii

et al. 2017

Int J Hematol

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“…Nevertheless, the literature contains some reports of successful cases of PAD in infants and children as young as 3 months of age and a success rate of 80-95% [4][5][6][7]. Prior to cardiac surgery in children aged between 3 and 15 years up to 5 PADs were conducted using cryotechnology [8]. Thereafter, 94% of these patients, and even all of the children younger than 5 years, were operated without allogeneic blood.…”

Section: Preoperative Autologous Blood Donationmentioning

confidence: 99%

Autologous Transfusion in Children: Blood-Saving Techniques

Kühbacher¹,

Innerhofer²

2004

Transfus Med Hemother

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It is uncontested that blood-saving strategies should also be applied in children. However, in the past, blood-saving techniques saw limited use in children although they are well-established in adults. This is due to technical and methodical problems but also to the physiologically limited compensatory mechanisms for diminished oxygen delivery in this age group. For this reason, the various blood-saving techniques cannot be universally applied to all age groups. During the first year of life most perioperative techniques are of only limited benefit: Even a small amount of blood loss in relation to total blood volume makes a transfusion of allogeneic blood necessary, which is far before enough shed blood can be recovered for re-transfusion. Preoperative autologous donation of blood calls for a high degree of cooperation by the child and the parents and is equally demanding in terms of organization and skills. Therefore, this procedure is used mainly in school-age children and in adolescents. Intraoperative blood salvage, by contrast, is already worthwhile in children of at least 1 year with an expected blood loss of 20% of blood volume. Acute normovolemic hemodilution and deliberate hypotension should be recommended only in an age group where cardiovascular compensatory mechanisms are given. Supporting procedures aimed at avoiding the need for allogeneic blood include perioperative administration of erythropoietin, iron supplementation, blood-saving surgical techniques and careful hemostasis. These prerequisites, the combination of various techniques as well as the definition of an age-specific low transfusion trigger have contributed to a marked decrease in the need for allogeneic blood products in children over the recent years.

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“…In 1995, Masuda et al reported that 94% of pediatric patients and 100% of those below the age of 5 years did not require homologous blood transfusion during their hospital stay. 6 The procedure was expensive and labor intensive and is obviously more expensive if the collected units are wasted. At one center, 49.7% of predonated blood was discarded.…”

Section: Preoperative Autologous Donationmentioning

confidence: 99%

“…25,29 In fact, it has been performed in cardiac lesion patients as young as 3 years of age and weighing as little as 12.7 kg. 6 An average volume phlebotomized can range from 10 to 20% 29 of circulating blood volume or to a reported maximum of 19 mL/kg. 30 For children less than 15 kg or with poor peripheral access, phlebotomy was carried out through the external jugular vein.…”

Section: Preoperative Autologous Donationmentioning

confidence: 99%

Blood Conservation During Pediatric Cardiac Surgery

Gómez

Olshove

Weinstein

et al. 2002

Transfus Alt Transfus Med

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1 Blood conservation techniques in adult and pediatric cardiac surgery have evolved over the past 50 years. Congenital cardiac surgical repair with CPB has induced up to a 300% hemodilutional effect.2,3 In the 1960s, disposable CPB equipment was developed and non-heme primes were utilized to reduce transfusion exposure. 4,5Today, the first question many parents ask is not "Is my child fine?" but "Did my child receive any blood?" The public's perception of banked blood being tainted has prompted surgeons to limit or eliminate blood transfusions. Autologous donation has helped reduce the need for homologous transfusion. In pediatrics, however, this technique is limited by kilogram weight.6 Indeed, weight loss and preoperative anemia have been found to be highly significant predictors for the need of red blood cell transfusion and postoperative morbidity. 7-12Cardiopulmonary bypass causes a total body inflammatory response and dilution of coagulation factors, a phenomenon which exacerbates postoperative bleeding. Preoperative treatment of anemia and coagulation imbalances has reduced blood transfusions. 13 The use of antifibrinolytics has changed transfusion patterns due to reduced postoperative bleeding. Cell salvaging systems have become commonplace in the operating room and intensive care unit. Modified ultrafiltration, commonly used in pediatrics, has been effective in increasing hematocrit (Hct) levels, concentrating patient plasma volume, and reducing the body's inflammatory response to cardiopulmonary bypass.

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Preoperative autologous blood donations in pediatric cardiac surgery

Cited by 26 publications

References 20 publications

Predictors of vasovagal reactions during preoperative autologous blood donation: a single-institution analysis

Predictors of vasovagal reactions during preoperative autologous blood donation: a single-institution analysis

Autologous Transfusion in Children: Blood-Saving Techniques

Blood Conservation During Pediatric Cardiac Surgery

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