Whole blood may do more harm than good in pediatric heart surgeries

WINSTON-SALEM, N.C. A standard medical practice at some of the nation's largest children's hospitals using whole, recently donated blood for certain infant open heart surgeries may do more harm than good. Researchers from Wake Forest University Baptist Medical Center and the University of Texas, Southwestern Medical School reported the findings in this week's New England Journal of Medicine.

"A long-time accepted practice has now been tested, and our results show it could actually be worse for infants," said Steven Mou, M.D., principal investigator and assistant professor of anesthesiology at Wake Forest Baptist. "Abandoning this practice could help reduce hospital stays for infants who have surgery for heart defects and help reduce some of the inventory problems that blood banks grapple with."

The study involved 200 children under age 1 who required heart surgery using the heart-lung bypass machine, which adds oxygen to blood and maintains circulation while the heart is stopped for surgery. The research team compared two different blood products used to fill, or "prime" the equipment: whole blood donated within the previous 48 hours and "reconstituted" blood formed by combining red blood cells and plasma. Plasma can be stored up to a year and red cells for 42 days after donation.

The results showed that patients who got the whole blood did no better in terms of bleeding, transfusion requirements, after-surgery complications and mortality than patients who got the reconstituted blood. In fact, infants who received the reconstituted blood had a shorter stay in the intensive care unit (70 hours versus 97 hours) and spent less time on respirator (36 hours versus 53 hours) which could also dramatically affect health care costs.

The researchers believe the differences were because the patients receiving reconstituted blood were observed to accumulate less fluid. Fluid accumulation is a marker for inflammation.

The research wa

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

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