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Bone marrow harvesting in children managed without allogenic blood
Author(s) -
DE SÁ V. PEREZ,
BÉKASSY A.,
SCHOU H.,
WERNER O.
Publication year - 1994
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.1994.tb00412.x
Subject(s) - medicine , anesthesia , bone marrow , venous blood , blood volume , surgery
Eleven children undergoing bone marrow harvesting were studied on 15 occasions to assess whether preoperative haemodilution and the acceptance of a transiently low haemoglobin concentration (5 g·dl −1 ) during anaesthesia, would obviate the need for giving allogenic blood. Before harvesting, 20 (8–28) ml·kg −1 of blood (median (range)) was collected in citrate‐phosphate‐dextrose (CPD) bags and replaced isovolaemically with dextran‐60 in Ringer's acetate. Replacement of the harvested volume (26 (17–42) ml·kg −1 ) was done with the same solution. The bag content was reinfused before awakening; red cells recovered during processing of the bone marrow 2–4 h postoperatively. The preoperative haemoglobin concentration (Hb) was 10.3 (8.7–12.3) g·dl −1 and central venous oxygen saturation ( S cvo 2 ) 82 (70–94)%. Hb decreased to 5.4 (4.7–8.4) g·dl −1 ( P < 0.01) at the end of harvest, and S cvo 2 to 76 (60–92)% ( P < 0.05). Retransfusion from the CPD bags increased Hb to 6.8 (5.8–9.5) g·dl −1 ( P < 0.05). After extubation Scvo 2 decreased to 67 (55–79)% ( P < 0.05). Reinfusing the harvested red cells increased Hb to 8.6 (6.6–10.5) g·dl −1 and S cvo 2 to 74 (59–78)%. Hb one week after the harvest was 11.0 (7.4–12.7) g·dl −1 . The authors conclude that the combination of preoperative and intraoperative haemodilution was well tolerated as judged from haemodynamics, S cvo 2 and pH and allowed large volumes of bone marrow to be harvested without the need for allogenic blood.