Pediatric Blood Management Team in Craniofacial Surgery
Josh Kelley, MD, Brian Boville, MD, Dominic Sanfilippo, MD, John Polley, MD, Robert Mann, MD, John Girotto, MD, MBA, FACS, FAAP.
Helen DeVos Children's Hospital, Grand Rapids, MI, USA.
Introduction: Craniofacial procedures require preparation and care. Transfusions are often required. Independent use of erythropoeitin or intraoperative tranexamic acid can reduce transfusion. Objectives: To determine if a Pediatric Blood Management (PBM) Team can reduce transfusion requirements in children undergoing craniofacial surgery. Methods: A protocol was developed which involved pre-operative optimization of hemoglobin, intraoperative use of tranexamic acid and CellSaverô technology, and blood sparing operative techniques. Patients were preoperatively screened for altered coagulation including hypofibrinogenemia and von Willebrand's disease. Prospective data on patients was collected. Retrospective data on 20 consecutive patients who underwent craniofacial surgery prior were used as controls. Results: Groups were similar in age and weight. Patients PBM post-intervention had a higher ASA classification. The rate of transfusion decreased to 65% post-intervention. Post-intervention, patients received a mean of 106 mL of intraoperative PRBC, while pre-intervention, patients received a mean of 224 mL. (p=0.024). Postoperative hemoglobin measurements were similar, with the control group 10.9 g/dL and the intervention arm 10.5 g/dL (p=0.64). Discharge hemoglobin concentrations also were similar with 9.6 g/dL and 10.6 g/dL in the control and PBM group, respectively (p=0.196). Furthermore, 3 patients were found to have von Willebrand's disease preoperatively and did not require transfusion. Conclusion: We found that the institution of a Pediatric Blood Management Team significantly reduced the transfusion burden of patients, including complex patients with von Willebrand's disease. The use of a multimodal approach to hematologic management optimized patients for their procedures and helped minimize exposure to transfusion associated complications.
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