MEDIASTINAL BLEEDING AFTER CARDIOPULMONARY BYPASS IN PEDIATRIC-PATIENTS

Background. The purpose of our review was to develop simple clinical r ecommendations to reduce the need for allogeneic blood transfusions in children undergoing cardiac operations. Methods. The literature on he mostasis as it relates to children, cardiac disease in children, and p ediatric heart surgery was reviewed. We also reexamined the efficacy o f several strategies in this patient population: on-site monitoring of coagulation, transfusion of fresh whole blood, and administration of desmopressin, E-aminocaproic acid, or aprotinin. Results. Children wit h heart disease may present with preoperative thrombocytopenia, reduce d platelet aggregation, and a decreased level of von Willebrand factor . Infants less than 6 months of age show a significant dilution of coa gulation factors and decreased platelet counts during cardiopulmonary bypass. Fresh whole blood reduces blood loss in children younger than 2 years undergoing complex operations. Desmopressin does not reduce bl eeding, whereas on-site monitoring, synthetic antifibrinolytics, and a protinin require further evaluation in pediatric cardiac surgical pati ents. Conclusions. The use of fresh whole blood to reduce blood loss i n children younger than 2 years undergoing complex heart operations is recommended. Therapy for excessive bleeding after cardiopulmonary byp ass will vary according to the patient's age, platelet count, and acti vated partial thromboplastin and prothrombin times.