Fresh whole blood for pediatric heart surgery ‘may reduce risk of transfusion-related illnesses’

30 Apr

For young children undergoing heart surgery, the use of fresh whole blood from single donors may reduce the risk of lifelong complications. This is according to a new study published in The Annals of Thoracic Surgery.
Blood transfusion bags
“We believe that our experience with the use of fresh whole blood demonstrates a consistent reduction in donor exposure compared with the exclusive use of components and potentially reduces the risks of transfusion,” say the researchers.

Study leader Dr. David R. Jobes, of The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, and colleagues note there is a high risk of immediate and long-term complications among patients receiving blood transfusions – particularly children.

“Patients may experience common and less life-threatening transfusion reactions, such as allergic and febrile reactions, or more serious complications such as transfusion-related acute lung injury and infectious disease transmission,” they explain.

“The risk for disease transmission in pediatric patients is essentially the same as the risk for adults,” adds Dr. Jobes, “but may be more costly over the long term because infants and young children may live longer with chronic illness stemming from transfusion.”

At present, component blood – consisting of blood parts such as red blood cells, platelets or plasma from multiple donors – tends to be the standard form of blood used for transfusion among children undergoing heart surgery.

“Currently, whole blood is not generally made available to hospitals for use in pediatric heart surgery,” says Dr. Jobes. “Blood centers separate donated blood into component parts which are then stored for use in medical transfusions as needed.”

There is a concern, however, that because the use of component blood exposes children to multiple donors, this raises their risk of transfusion-related complications.

For their study, Dr. Jobes and his team set out to assess the effectiveness of a program conducted at The Children’s Hospital that aimed to reduce donor exposure for elective heart surgery patients aged 2 years and under by using two units of fresh whole blood for each procedure.

In the program, fresh whole blood was defined as blood that had been collected less than 48 hours before being used for surgery and had not be divided into separate components.

Fresh whole blood lowers donor exposure, possibly reducing transfusion-related illnesses

In their analysis, Dr. Jobes and colleagues assessed the blood bank records and surgical registry data from 1995 to 2010 of 4,111 pediatric patients with an average age of 94 days.

Of these patients, 3,836 received fresh whole blood, while 252 received blood components due to the unavailability of fresh whole blood.

The researchers found that the youngest patients whose heart procedures were complex were exposed to the highest number of blood donors, while older patients who underwent simpler heart procedures were exposed to the fewest number of blood donors.

On comparing the number of blood donor exposures among children in the program with those detailed in published reports of component blood use, the researchers found that overall, the use of fresh whole blood was associated with a lower number of donor exposures.

These findings, the researchers say, indicate that the use of fresh whole blood can lower the risk of transfusion-related illnesses among pediatric heart surgery patients.

The team adds:

“Most young patients undergoing complex surgical procedures will continue to require multiple transfusions. For those patients, we believe that our experience with the use of fresh whole blood demonstrates a consistent reduction in donor exposure compared with the exclusive use of components and potentially reduces the risks of transfusion.”

In addition, the researchers say their findings should encourage health officials to review the current blood storage practice and make fresh whole blood more widely available for pediatric patients.

“Our experience also demonstrates that the provision of fresh whole blood, although logistically complicated and dependent on cooperation and careful communication, is feasible as a sustainable operating protocol between a blood center, a blood bank and the pediatric cardiothoracic surgery service they support,” they add.

Logistical issues likely to limit the use of fresh whole blood

In an editorial linked to the study, Dr. Julie Cleuziou, of the German Heart Center in Munich, says the findings from Dr. Jobes and colleagues “demonstrates very nicely” that the use of fresh whole blood leads to fewer donor exposures than the use of component blood, which may lower the risk of complications linked to transfusions.

She cautions, however, that – as stated by the researchers – the widespread use of fresh whole blood does present some logistical problems that would need to be addressed.

“Cooperation and meticulous communication between a blood center that will provide the blood bank with fresh whole blood and the cardiothoracic surgery service is essential,” she notes. “Furthermore, the need for regular and reliable blood donors is extremely important because fresh whole blood needs to be used within 48 hours and necessitates thorough testing for a vast amount of infectious diseases.”

“This complex logistic organization will limit the use of fresh whole blood to specialized centers dealing with a large number of patients having a reliable blood center in place, and to elective operations that can be planned.”

In May 2013, Medical News Today reported on a study published in The Lancet, in which researchers claim blood transfusions are overused during common heart surgery.