Validation of a theoretically derived model for the management of massive blood loss in pediatric patients – a case report

Abstract

We present the case of a 5-year-old girl who was brought to hospital having suffered an intracranial bleed. She was found to have a large cerebral arteriovenous malformation which was unsuitable for coiling. Uncontrollable raised intracranial pressure refractory to all therapies necessitated surgery as a last resort. Massive hemorrhage eventuated during the procedure with the estimated loss of between five and six blood volumes, the majority occurring within the space of an hour and a half. We describe management using a locally developed protocol and correlate this with laboratory findings.

Paediatric massive transfusion

“…Blood loss being approximated as one-third of crystalloid or an equivalent volume of colloid replacement required to maintain haemodynamic stability. 3 Of note, the estimated blood volume of a preterm infant is 90-100 ml kg −1 , a term infant <3 months 80-90 ml kg −1 , and a child >3 months 70 ml kg −1 . 1…”

Pediatric Combat Trauma

“…Along with these retrospective studies, several prospective observational studies have sought to further refine current trauma transfusion practices [27]. The widespread and enthusiastic adoption of Bbalance resuscitation^practices in the adult population has translated into changes in pediatric care as well [28][29][30][31][32][33]. This shift in balanced resuscitation for injured children, however, has not been thoroughly studied due to the relative infrequency of massive transfusions in children.…”

Massive transfusion in children and neonates

“…Therefore, paediatric practices vary significantly among institutions (Ringer et al, 1998;Laverdiere et al, 2002). Unfortunately, the experience with paediatric-specific MTPs is, in comparison, extremely limited (Barret et al, 1999;Paterson, 2009;Dressler et al, 2010;Pickett & Tripi, 2011;Chidester et al, 2012;Hendrickson et al, 2012b). Moreover, blood banking logistics make incorporating paediatric MTPs challenging for institutions that are not free-standing children's hospitals, meaning that a single 'adult' MTP will need to be used for both adult and paediatric patients.…”