Preoperative autologous donation of blood for a simple cardiac anomaly: Analysis of children weighing under twenty kilograms

Objective: Preoperative autologous donation of blood has been expanded to c ardiac operations in children. However, because of problems such as lack of cooperation and hemodilution during cardiopulmonary bypass, its efficacy i n small children is unclear. This study clarifies the clinical significance of preoperative autologous donation of blood in small children. Methods: Thirty-seven patients weighing under 20 kg (age range, 3-9 years; weight range, 13-20 kg) underwent preoperative autologous donation and card iac operations to treat a simple anomaly. Twenty-five age- and weight-match ed patients who were not cooperative or refused preoperative autologous don ation served as control subjects. Autologous blood was collected by the sim ple or leapfrog method and stored as blood components. Each collecting volu me was 5 to 10 mL/kg. Results: The donation was performed 6 +/- 2 times during 50 +/- 16 days, an d the whole storage volume was 48 +/- 17 mL/kg, There was no serious com pl ication. The minimum hematocrit level negatively correlated with the primin g volume of cardiopulmonary bypass (preoperative donation patients: P <.01, r(2) = 0.4; control subjects: P =.5, r(2) = 0.03). Blood loss did-not sign ificantly differ between preoperative donation patients and control subject s, and the transfused blood volumes were 43 +/- 13 mL/kg and 29 +/- 22 mL/k g, respectively. All of the autologous blood products but fresh frozen plas ma were reinfused. Use of homologous blood was significantly less in preope rative donation patients than in control subjects (0% vs 80%, P <.01). In p re operative donation patients postoperative recovery in hemoglobin level w as significantly better, which is concurrent with a higher reticulocyte lev el. Conclusion: Preoperative autologous donation can be performed safely with c linical efficacy, even in children under 20 kg. This can be improved furthe r through coupling with another procedure.