Blood Conservation in the Perioperative Setting

Children undergoing high blood loss surgical procedures face the same risks associated with transfusion as adults but must live with the sequelae of transfusion-related complications throughout a much longer life span. Avoidance of allogeneic blood transfusion can be accomplished with a team approach that relies on a thorough understanding of patient- and procedure-associated risk factors for bleeding, allowing patients who might benefit from a perioperative blood conservation strategy to be identified. The individual components of a multidisciplinary, multimodal blood conservation plan are discussed in this chapter. These elements include preoperative erythropoietin therapy, perioperative autologous blood collection (preoperative autologous donation, intraoperative hemodilution and cell salvage), antifibrinolytics, deliberate hypotension, and blood sparing surgical techniques. The adoption of lower transfusion triggers, institutional transfusion algorithms, and reduced blood sampling can result in fewer transfusions for all pediatric surgical patients.