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Blood-Conservation Techniques in Craniofacial Surgery

Meara, John G. MD, DMD, FRACS*; Smith, Ebonie M.; Harshbarger, Raymond J. MD; Farlo, Joe N. MD§; Matar, Marla M. MD§; Levy, Mike L. MD

doi: 10.1097/01.sap.0000157901.57961.3b
Original Article
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Attempts at reducing exposure to allogeneic transfusions, using blood conservation techniques such as controlled hypotension and normovolemic hemodilution, have met with mixed results and are not always practical in small infants. Recombinant human erythropoietin (RHE), a hormone that stimulates RBC production, increases the hematocrit when administered to infants.

A retrospective chart review of all patients undergoing fronto-orbital advancement for craniosynostosis by the same plastic surgeon between January 2002 and December 2002 was conducted. A subgroup of patients (10/19) received RHE as a blood-conservation strategy.

Transfusion requirements were lower in the RHE group (5/10) versus the control group (9/9). Total volume of blood products transfused was statistically lower in the RHE group (154 mL RHE group versus 421 mL control) (P < 0.03).

RHE combined with blood-conservation techniques was associated with a decreased need for blood transfusion, thus exposing the patient to fewer risks associated with allogeneic transfusion.

Ten of 19 patients undergoing fronto-orbital advancement for craniosynostosis received preoperative Recombinant Human Erythropoietin (RHE) weekly. The total volume of blood products transfused was lower in the RHE group.

From the *Royal Children's Hospital, Melbourne, Australia; †University of Southern California School of Medicine, Los Angeles, CA; ‡Department of Plastic Surgery, Walter Reed Army Medical Center, Washington, DC; §Department of Anesthesia, Childrens Hospital Los Angeles, Los Angeles, CA; and ¶Children's Hospital and Health Center, San Diego, CA.

Received June 3, 2004 and accepted for publication, after revision, July 13, 2004.

Reprints: John G. Meara, MD, DMD, FRACS, Director, Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia. E-mail: john.meara@rch.org.au

© 2005 Lippincott Williams & Wilkins, Inc.