Blood transfusion support in pediatric cardiovascular surgery

The majority of children who undergo open-heart surgery with cardiopulmonar y bypass (CPB) require perioperative blood transfusion. Blood product requi rements are affected by factors such as patient age, underlying cardiac dis ease, complexity of the surgical procedure, and hemostatic alterations indu ced by CPB. Transfusion support may include the use of whole blood and/or i ndividual blood components with transfusion practices varying widely based on individual preferences and blood product availability. Approaches to lim it allogeneic blood exposure include the use of modified ultrafiltration an d smaller bypass circuits, preoperative autologous blood donation and intra operative blood salvage, and adjunctive antifibrinolytic agents. Potential advantages and disadvantages of the different blood products and pharmacolo gical agents must be considered in managing the pediatric cardiac surgery p atient. (C) 1999 Elsevier Science Ltd. All rights reserved.