Blood Loss and Transfusion in Children Undergoing Neurosurgery

Pediatric blood transfusion practices during neurosurgical procedures differ from those of adults with regard to physiologic and hematologic considerations. Such differences dictate different guidelines for blood transfusion practices. In addition, pediatric patients are more susceptible to certain transfusion-related complications as compared to their adult counterparts. The pediatric patients present with more incidence of allergic, febrile non-hemolytic, and hypotensive transfusion reactions. Oxygen consumption in children is higher as compared to adults. As the myocardium of a newborn operates to the full potential to meet the higher oxygen demand, it may not be able to compensate for diminished oxygen capacity by further increasing cardiac output and, thus, have a higher likelihood of cardiac decompensation and ischemia under stressful circumstances. Optimal hemoglobin concentrations are, thus, higher in newborns as compared to the adults. The term neonate has mean hemoglobin values of 16.5 gm/dL, and the hemoglobin concentrations vary in children and adolescents in an age-related manner. Fetal hemoglobin (HbF) in the full-term newborn is highest at birth, decreasing at 5% per week until 6 months. Children undergoing neurosurgery are vulnerable to intraoperative bleeding; some preocedures are prone to massive blood loss. A diverse physiology from adults precludes the pediatric patients from enduring even a small quantity of blood loss over a short duration. The management, in such scenario, requires throrough understanding of body physiology, usage of blood products, and appropriate monitoring methods.