Fresh Whole Blood Reduces Transfusion-Related Illnesses for Pediatric Heart Surgery

The use of fresh whole blood from single donors may reduce the risk of lifelong complications for young children undergoing heart surgery.

At present, component blood consisting of blood parts such as red blood cells, platelets or plasma from multiple donors tends to be the standard form of blood used for transfusion among children undergoing heart surgery, but the use of component blood exposes children to multiple donors, and raises their risk of transfusion-related complications.

Critical care physicians at The Children's Hospital of Philadelphia (Philadelphia, PA, USA) assessed the blood bank records and surgical registry data from 1995 to 2010 of 4,111 pediatric patients with an average age of 94 days. Of these patients, 3,836 received fresh whole blood, while 252 received blood components due to the unavailability of fresh whole blood. Blood was obtained from daily donations 24 to 48 hours before operation, underwent standard labeling and testing for transmissible disease, was stored at 4 °C, and was delivered to the hospital the evening before operation.

The investigators found that the youngest patients whose heart procedures were complex were exposed to the highest number of blood donors, while older patients who underwent simpler heart procedures were exposed to the fewest number of blood donors. On comparing the number of blood donor exposures among children in the program with those detailed in published reports of component blood use, they found that overall the use of fresh whole blood was associated with a lower number of donor exposures. This indicated that the use of fresh whole blood can lower the risk of transfusion-related illnesses among pediatric heart surgery patients.

The authors concluded that most young patients undergoing complex surgical procedures will continue to require multiple transfusions. For those patients, they believe that their experience with the use of fresh whole blood demonstrates a consistent reduction in donor exposure compared with the exclusive use of components and potentially reduces the risks of transfusion. Their experience also demonstrates that the provision of fresh whole blood, although logistically complicated and dependent on cooperation and careful communication, is feasible as a sustainable operating protocol between a blood center, a blood bank and the pediatric cardiothoracic surgery service they support. The study was published on March 25, 2015, in the journal the Annals of Thoracic Surgery.

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