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Pediatric Transfusion Practices Dr Gary Simon

Pediatric Transfusion Practices. Blood ConservationPreoperative Autologous DonationPreoperative ErythropoetinAcute Normovolemic HemodilutionAntifibrinolyticsIntraoperative Blood SalvageControlled hypotensionTopical agentsTemperature control. 05/05/2010. Pediatric transfusions - Physiology. P

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Pediatric Transfusion Practices Dr Gary Simon

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    1. 05/05/2010 Pediatric Transfusion Practices Dr Gary Simon Physiology Differences between adult and neonate Implications Transfusion reactions Acute transfusion reactions Delayed transfusion reaction Coagulopathy Transmission of infectious diseases Sepsis Metabolic changes Physicial Dept of Anesthesiology and Perioperative Care

    2. Pediatric Transfusion Practices Blood Conservation Preoperative Autologous Donation Preoperative Erythropoetin Acute Normovolemic Hemodilution Antifibrinolytics Intraoperative Blood Salvage Controlled hypotension Topical agents Temperature control 05/05/2010

    3. Pediatric transfusions - Physiology Physiology differences neonate vs child/adult Children have higher oxygen consumption and a higher cardiac output to blood volume ratio than adults The neonatal myocardium operates at near maximum level of performance as a baseline. The newborn’s heart may be unable to compensate for a decreased oxygen carrying capacity by increasing cardiac output. The neonatal myocardium will also suffer a greater degree of decompensation when exposed to decreased oxygen delivery. 05/05/2010

    4. Pediatric transfusions - Physiology Fetal hemoglobin (HbF) comprises 70% of full term and 97% of premature infants’ total hemoglobin at birth. Red blood cells (RBCs) containing HbF have a shorter life span (90 days) than those containing primarily adult hemoglobin (HbA) (120 days) HbF interacts poorly with 2,3,DPG. Therefore the P50 decreases from 26 mmHg with HbA to 19 mmHg with HbF The optimal hemoglobin values in the newborn are higher than those of older patients (14-20 g/dl). Physiologic nadir for hemoglobin occurs at approximately 2–3 months of age (term -11, prem – 9.5) 05/05/2010

    5. Pediatric transfusions - Physiology 05/05/2010

    6. Pediatric transfusions - Physiology The P50 decreases from 26 mmHg with HbA to 19 mmHg with HbF. This leftward displacement of the oxygen–hemoglobin dissociation curve means decreased oxygen delivery to tissue because of the high affinity of HbF for oxygen. HbF production diminishes until only a trace is present at 6 months of age.The younger the infant, the higher the fraction of HbF and thus the lower the oxygen delivering capacity. Hemoglobin levels that are adequate for the older patient may be suboptimal in the younger infant or neonate. 05/05/2010

    7. Pediatric transfusions - Physiology

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