Error traps in Pediatric Patient Blood Management in the Perioperative Period
Pediatric Anesthesia
Submitted September 2023 by Dr Liam O'Doherty
Summary: This review article provides a practical guide to optimise perioperative blood management in children. It identifies 5 ‘Error Traps’ in blood management. 1. Failure to recognise and treat perioperative anaemia. 2. Failure to obtain informed consent regarding blood conservation strategies and optimal blood component use. 3. Failure to consider specific intraoperative blood conservation techniques in children. 4. Failure to recognise and treat life-threatening haemorrhage in children. 5. Failure to prevent unnecessary transfusion and recognise the risks of over-transfusion.
Take home messages/commentary:
These error traps can provide the following ‘take home’ points:
- Have a strategy to identify and treat pre-operative anaemia. This may be prevalent in up to 68% of Australian Aboriginal children.
- Gain informed consent regarding blood products whilst including the paediatric patient who is mature enough to engage in the consent process. Address family specific issues e.g. Jehovah’s Witness.
- Consider cell salvage if >10% blood loss is expected in patients >10kg.
- Acute normovolaemic haemodilution has theoretical benefits.
- Use tranexamic acid if moderate to severe bleeding is expected.
- Paediatric massive haemorrhage may often be overlooked due to clinical variability, therefore be vigilant to monitor for signs of massive haemorrhage. Use a paediatric specific massive haemorrhage protocol.
- Avoid unnecessary or over-transfusion by identifying triggers and targets for blood product replacement. Consider avoiding transfusion in stable patients with Hb >7g/dL. Post-transfusion aim to target an Hb of 7-9 g/dL with consideration of other clinical factors.
