"No allogeneic blood transfusion" protocol for the surgical correction of craniosynostoses - I. Rationale

Improved anesthesiological and surgical carl has resulted in a progressivel y declining need for allogeneic blood transfusion. In infants with craniosy nostosis, however, allogeneic blood transfusion is still performed as a rou tine procedure. In the present paper, the authors describe a protocol they have devised with the aim of limiting or even avoiding allogeneic blood tra nsfusion even in very young patients, consequently avoiding the risks of in fective or immunologic reactions associated with the procedure. The protoco l is based on stimulation of the hematopoietic system with erythropoietin, selection of an appropriate age for operation when a favorable balance betw een fetal and adult-type hemoglobin is established (that is after 4-6 month s), preoperative preparation of the autologous blood supply, and intraopera tive blood salvage.