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J Thorac Cardiovasc Surg 2000;120:783-788
© 2000 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

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

From The Second Department of Surgery, Kagoshima University Faculty of Medicine, Kagoshima, Japan.

Address for reprints: Hiroshi Masuda, MD, The Second Department of Surgery, Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520 Japan (E-mail: masuda{at}med6.kufm.kagoshima-u.ac.jp).

Objective: Preoperative autologous donation of blood has been expanded to cardiac operations in children. However, because of problems such as lack of cooperation and hemodilution during cardiopulmonary bypass, its efficacy in 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 cardiac operations to treat a simple anomaly. Twenty-five age- and weight-matched patients who were not cooperative or refused preoperative autologous donation served as control subjects. Autologous blood was collected by the simple or leapfrog method and stored as blood components. Each collecting volume was 5 to 10 mL/kg.
Results: The donation was performed 6 ± 2 times during 50 ± 16 days, and the whole storage volume was 48 ± 17 mL/kg. There was no serious complication. The minimum hematocrit level negatively correlated with the priming volume of cardiopulmonary bypass (preoperative donation patients: P < .01, r² = 0.4; control subjects: P = .5, r² = 0.03). Blood loss did not significantly differ between preoperative donation patients and control subjects, and the transfused blood volumes were 43 ± 13 mL/kg and 29 ± 22 mL/kg, respectively. All of the autologous blood products but fresh frozen plasma were reinfused. Use of homologous blood was significantly less in preoperative donation patients than in control subjects (0% vs 80%, P < .01). In preoperative donation patients postoperative recovery in hemoglobin level was significantly better, which is concurrent with a higher reticulocyte level.
Conclusion: Preoperative autologous donation can be performed safely with clinical efficacy, even in children under 20 kg. This can be improved further through coupling with another procedure.

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