Intraoperative Autologous Blood Transfusion in the Surgical Correction of Craniosynostosis

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Abstract
Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. The objective of this study was to ascertain the risks, benefits, and effects on transfusion rates associated with the use of intraoperative autologous transfusion (IAT) in this patient population. The Haemonetics Cell Saver 4 (Haemonetics Corporation, Braintree, MA) autotransfusion system was used to salvage blood in 18 patients undergoing the release of stenosed calvarial sutures. In a prospective, nonrandomized study, these patients were compared with a control group of similar age, gender, weight, and surgical procedures. There were 10 male patients and 8 female patients; the mean age was 7.2 months, the mean weight was 8.67 kg, and the mean surgical time was 3.15 hours. The mean amount of homologous blood transfused to the control group was 189 ml, compared with 87.69 ml for the IAT group, which was a decrease of 46.3%. The mean amount of autologous blood transfused was 150 ml (range, 50-250 ml). Thirty-three percent of the patients in the IAT group did not require homologous blood transfusion. No complications were observed with the use of the Cell Saver in the IAT group. The use of the Cell Saver was associated with a significant decrease in the amount and rate of homologous blood transfusions. Its use appears to be safe in pediatric patients undergoing craniosynostotic surgery.