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Clinical Pathology Selected Abstracts, 1/14

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Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.

Predictive factors for blood transfusion in living donor pediatric liver transplantation

Patients undergoing liver transplantation, in particular pediatric liver transplantation, may receive massive transfusion. However, technical surgical improvements over the years have made it possible for many patients undergoing pediatric living donor liver transplantation (LDLT) to avoid transfusion. Yet a few patients will undergo massive blood transfusion to replace the loss of more than one estimated circulating blood volume, which is associated with increased perioperative morbidity and mortality. The authors conducted a study to identify the preoperative risk factors that can predict the requirement for massive transfusion in this population. They reviewed retrospectively the anesthesia charts of pediatric patients undergoing LDLT. The study involved 198 pediatric patients, 13 of whom met the definition for massive transfusion. The other patients were grouped accordingly with patients who did not require massive blood transfusion. The two groups were then compared. The authors concluded that the patients requiring massive transfusion were younger and had a smaller body size and prolonged international normalized ratio (INR). The only predictive factor for bleeding was the INR. Furthermore, each prolongation of 0.1 unit of INR elevated the risk of requiring a massive blood transfusion by 1.083-fold. The authors concluded that INR was the only predictive factor for massive transfusion during LDLT. They recommend increasing the ratio of fresh frozen plasma transfusion in patients with prolonged INR before or during pediatric LDLT.

Huang C-J, Kwok-Wai C, Chen C-L, et al. Predictive factors for pediatric patients requiring massive blood transfusion during living donor liver transplantation. Ann Transplant. 2013;18:443–447.

Correspondence: Chih-Hsien Wang at cchwang@adm.cgmh.org.tw

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