Pediatric scoliosis surgery possible without requiring blood transfusion

Only two children in the study group received homologous blood transfusions, both of which were done outside of the study protocol.

Adolescent idiopathic scoliosis surgery can be performed without homologous blood transfusion when appropriate blood conservation measures are used, according to a study by British researchers.

J. Brad Williamson, FRCS, and colleagues at the Royal Manchester Children's Hospital, England, retrospectively reviewed their results performing scoliosis surgery after their center's pediatric sinal surgery practice implemented a protocol aimed at avoiding homologous blood transfusion. The study included 38 children treated with the protocol. The researchers compared these patients to control group of 32 children who received surgery before the protocol was initiated.

Surgeons performed sequential combined anterior and posterior spinal surgery in 24 study group patients and 18 control group patients. Posterior spinal surgery alone was performed in 14 study group patients and 14 control group patients, according to the study.

All study group patients had been assigned a transfusion trigger hemoglobin level of 7 g/dl, the authors noted. These patients also participated in at least one of the following blood conservation strategies:

preoperative autologous blood donation;
acute normovolemic hemodilution;
controlled perioperative hypotension;
aprotonin use; and
intraoperative cell salvage.

Children treated using the blood-conserving measures had a significantly lower mean estimated blood loss (P=.005). Additionally, 36 of the 38 children treated with these measures did not receive blood transfusions, according to the study.

The two patients who did receive transfusions were transfused by junior members of the center's critical care staff. In both cases, the transfusion was done without consulting the surgical or anesthetic teams and fell outside the agreed protocols, the authors noted.

"Had the protocols been observed, the study group would not have been exposed to any homologous blood products," they said, noting only 6 of 83 units of pre-donated blood were not required and were subsequently discarded.

For the control group, 167 units of blood had been cross-matched and 126 units were used, with an average of 3.94 units transfused per patent. Surgeons also used 36 pints of fresh-frozen plasma, according to the study.

"We have shown that when comprehensive blood-conservation strategies are used, it is possible to perform complex spinal surgery in healthy children without the need for homologous blood transfusion," the authors said.

For more information:
Verma RR, Williamson JB, Dashti H, et al. Homologous blood transfusion is not required in surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Br. 2006;88-B:1887-1891.