Iona Dockienė, Nijolė Savičienė, Vita Zupkauskienė, Vidūnas Daugelavičius, Rokas Daugelavičius
Abstract
About 70 spine surgeries are done for children with congenital, idiopathic or paralytic scoliosis in Vilnius Children’s hospital every year. There were significant blood loss and allogeneic blood transfusions (up to 70%) to correct anemia during this type of surgeries and postoperatively. Different techniques and methods have been used to collect and return blood during operation (anemia correction with iron supplement therapy preoperatively, deliberate hypotension during surgery, careful patient positioning to decrease intraabdominal pressure, meticulous surgical hemostasis, cell saver 3 plus system). Since 2009 we started to use OrthoPAT® orthopedic perioperative autotransfusion system. This system is a fully automated device that collects, washes, and returns your patients’ blood during and after orthopedic surgery helping to give them the best chance at avoiding unnecessary allogeneic transfusions and related risks of infection. The main aim was to reduce or escape allogeneic blood transfusions for children undergoing spinal surgery when OrthoPAT® system was used. The patient shed bloods was collected during surgery and postoperatively from wound drains (up to 6 hours) and after salvaging autologous RBC were reinfused to the same patient during operation and after surgery in ICU. From 2009 to 2012 we used orthopedic perioperative auto transfusion system for 80 children from 3 to 17 years old. Hemoglobin (Hb), hematocrit (Ht) rates were analyzed before surgery and the lowest rate after surgery during the first or the second postoperative day. Blood loss volume was evaluated during and after surgery. Collected blood volume perioperatively, demand on additional allogeneic blood, surgery time, length of stay in hospital and correlation between patient weight and lost and collected blood volume, demand of additional allogeneic transfusion were analyzed. We concluded that blood loss in our cases depends on surgery time (p<0.05). Allogeneic transfusions were required for lower weight children with bigger blood losses in the perioperative period (p<0.05). Stay in the hospital depends on surgery time, blood loss, reinfused autologous blood volume (p<0.05). 64% of our patients did not require allogeneic blood transfusion after spinal surgery. Patients who were reinfused with autologous blood volume more than 35% their EBV (estimated blood volume) did not require additional allogeneic blood transfusions (p<0.05). Allogeneic blood transfusion was required for patiens who lost average 50% their EBV (estimated blood volume) (p<0.05). Conclusions: Automatic blood salvaging is effective to reduce or totally escape allogeneic blood transfusions for children undergoing spinal surgery. Necessity of allogeneic blood transfusion mainly depends on lost and reinfused blood volume part of EBV.
Keyword(s): children spinal surgery; blood loss; autologous blood; allogeneic blood; correction of anaemia
DOI: 10.5200/392
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