Using fresh whole blood lowers patients’ exposure risk in child heart surgery

Researchers suggest that officials re-examine blood storage practice.  Infants and children who undergo heart surgery are better off receiving fresh whole blood transfusions from a single donor, compared to receiving component blood from multiple donors, according to new research at The Children’s Hospital of Philadelphia (CHOP).

“Using fresh whole blood for transfusions reduces the number of individual blood donors to which patients are exposed,” said study leader David R. Jobes, M.D., a cardiothoracic anesthesiologist in the Cardiac Center at CHOP. “The risks of transfusion reaction are most significantly linked to donors, so limiting such exposure will benefit patients.” Well-recognized risks include allergic reactions, fevers, lung injury and the transmission of infectious disease.

Jobes and colleagues published their findings in the May 2015 issue of the Annals of Thoracic Surgery.

The research team did a retrospective study of 4,111 children receiving heart surgery at CHOP from 1995 to 2010. Of that number, 3,836 patients received fresh whole blood and 252 received only blood components. Since 1995, CHOP has provided fresh whole blood in heart surgery patients, relying on components only when whole blood was not available. Previous experience at CHOP had shown that using whole blood in heart patients reduced blood loss and lowered the need for subsequent transfusions.

In the current study, the median number of exposures was two donors, with higher numbers for younger patients having complex surgeries. For all the subgroups, the number of exposures was lower than amounts reported in scientific literature for pediatric cardiac patients who received blood components. The current practice in nearly all pediatric cardiac surgical programs is to rely solely on blood components.

“Many congenital heart conditions necessitate multiple surgeries beginning in infancy, and require multiple transfusions over a patient’s lifetime,” said Jobes, “so limiting donor exposures from the start may reduce long-term complications from blood transfusions. We hope this research encourages officials to re-examine current blood storage practice and make logistical changes to make whole blood more readily available for pediatric heart patients.”

David R. Jobes, Deborah Sesok-Pizzini and David Friedman, “Reduced Transfusion Requirement With Use of Fresh Whole Blood in Pediatric Cardiac Surgical Procedures,” Annals of Thoracic Surgery, May 2015. http://doi.org/10.1016/j.athoracsur.2014.12.070

IMAGE: DR. DAVID JOBES IS A CARDIOTHORACIC ANESTHESIOLOGIST AT THE CHILDREN’S HOSPITAL OF PHILADELPHIA. view more 

CREDIT: THE CHILDREN’S HOSPITAL OF PHILADELPHIA