Should We Implement Type and Screen Transfusion Policy in Pediatric Cardiac Surgery to Improve Patient Blood Management?

Abstract

Bleeding during or after cardiac surgery is common in adults and associated with signi fi cant utilization of blood products. 1 There is very little evidence available on patient blood management in pediatric cardiac surgery. Children typically receive transfusions perioperatively for many reasons, including developmental alterations of their hemostatic sys-tem, hemodilution, and hypothermia with cardiopulmonary bypass, systemic anticoagulation, etc. The complexity of their surgical procedures, complex cardiopulmonary inter-actions, and risk for inadequate oxygen delivery and post-operative bleeding further contribute to blood product utilization in this vulnerable population. Till date, most of the blood centers in India follow blood typing and crossmatch policy as a part of pretransfusion testing to select the right blood for these patients. In this policy, patients are typed for their ABO/RhD and received red cell transfusions based on the antihuman globulin crossmatch results. However, in type and screen policy, the transfusion services perform ABO/RhD typing and a screen for atypical antibodies of the patient ’ s blood and plasma. A negative antibodyscreen signi fi es that the patient does not demonstrate any clinically signi fi cant antibodies and, therefore, only an immediate spin or abbreviated crossmatch is required. Because an immediate spin crossmatch is a fairly simple test, taking approxi-mately 10minutes in comparison to full crossmatch that takes around 45minutes, blood is available rather quickly if the need should arise. Since blood is not unnecessarily crossmatched and reserved for a patient who might not