Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery.

Stricker PA, Shaw TL, Desouza DG, et al.
Paediatr Anaesth 2010;20(2):150-159.
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The authors report their experience with the management of massive transfusion (MT) in 159 children operated between 2001 and 2006. 69 children (43%) lost less than 1 blood volume (BV) while 74 (47%) lost between 1 and 2 BV. The authors report that the concomitant administration of FFP (in a 1:1 ratio with RBC) improved postoperative hemostatic variables. While this approach may appear reasonable in the context of important blood losses in small patients, it should be remembered that 1) the benefits of a formula-driven transfusion protocol have not been demonstrated clearly and 2) at least 40% of patients may not have required FFP given blood losses less than 1 BV. Older children with larger BV may lose proportionally less blood and present a lesser tendency to postoperative hemostatic disturbances.

– Jean-Franois Hardy