arm). This study added support to the theory that children will tolerate a more
restrictive transfusion threshold without an increase in adverse events, similar to
the results seen in adults [1].
Overall, children appear to have better outcomes with a more restrictive
transfusion protocol. Set transfusion thresholds of 7 g/dl similar to adult trials
appear to be tolerated well in the pediatric population although the diverse
patient population seen in pediatric intensive care units prevents one from
making a single threshold that is all inclusive. Certain subsets of patients, such
as sickle cell patients who have better postoperative outcomes when transfused
to a hemoglobin of 10 g/dl, require the surgeon to treat each patient individually
and consider the underlying pathophysiology that is treated when deciding upon
an appropriate transfusion threshold [17].
V. Transfusion of Platelets
Transfusion of platelets and other factors typically follow the
recommended guidelines from adult surgical practice. The normal platelet count
of neonates and older children is similar to that seen in adults. Replacement of
depleted or congenitally absent factors, as seen in hemophilia, is done with
specific factors such as factor VIII or IX. These factors should be replaced prior
to surgical intervention and routinely monitored after surgery to ensure
hemostasis. Consultation with a hematologist to guide therapy should be
performed.