Nineteen years of experience with autotransfusion for elective surgery in children: more troublesome than we expected

Abstract

Background: Under the rationale that children undergoing elective surgery are the best candidates for autologous blood donors because of their long life expectancy, aggressive donations of autologous blood, even from infants, have been reported. A number of problems are associated with the procedure, however, whereas the risks of homologous blood are very low.

Study design and methods: From 1987 through 2005, of 5792 patients referred to blood transfusion services at two Japanese university hospitals for autologous blood donations, 314 children younger than 16 years old served as subjects for assessment.

Results: Of 314 children, 7 were not suitable as autologous donors. In most cases this was due to uncooperative behavior. Over a follow-up period of 19 years, the authors encountered 53 cases (17.3%) of donation-related problems, and this rate was higher than the 6 percent rate recorded for adult cases (316/5305). Nine children suffered crucial complications such as vasovagal reactions, and one 14-year-old boy required a vasopressor drug. Important findings were that 6 of these were first-time donors, and the amount of blood drawn was under 10 percent of their estimated blood volume.

Conclusion: Of 53 donation-related problems, 9 (17.0%) were accompanied by marked hypotension. Drawing autologous blood from children has become easier with advanced devices; however, lessening of anxiety and tension are essential for the safety of children's autologous blood donation programs. Aggressive donation should be avoided.

Figure 1

Special blood bag for children's donation of autologous blood. Anticoagulant in the large bag (1) was moved to the small bag (2), and then approximately 1 mL of it was pulled into a syringe (3). After venipuncture with a needle (4), which had a size corresponding to that of the veins, approximately 9 mL of blood was drawn into a syringe (3) followed by gentle mixing with anticoagulant, and then the mixture was pushed into the large bag (1). This process was repeated carefully until the amount of blood reached the mark a doctor had set.

Figure 2

Distribution of patients. Of 5792 patients, 314 were children under the age of 16 years. Seven cases were excluded as donor patients, and consequently 307 individuals donated autologous blood. A total of 291 of them (94.8%) were operated on without a homologous blood transfusion. AB = autologous blood; HB = homologous blood.

Figure 3

Time course change of number of patients. (□) Number of adults; (▪) children.

Figure 4

Number of patients classified by clinical department.

Figure 5

Change in Hb level during donation period. Bold line indicates the time course change in mean (±SD) Hb level of all the donor children. The two fine lines (○, □) indicate the two children who were given rHuEPO( ).