PB0657 - Cold stored-fresh whole blood in pediatric cardiac surgery: implications for hemostasis and blood donor exposure

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

Amy Kiskaddon, PharmD, MBA

Assistant Professor of Pediatrics
Johns Hopkins University, Florida, United States
JA

Jennifer Andrews

Associate Professor of Pathology, Microbiology and Immunology (Division of Transfusion Medicine)
Vanderbilt University Medical Center
Nashville, Tennessee, United States
CJ

Cassandra Josephson

Professor, Oncology, Pediatrics, and Pathology
Johns Hopkins University School of Medicine
Saint Petersburg, Florida, United States
MK

Michael Kuntz

Assistant Professor, Pediatric Cardiac Anesthesiology
Vanderbilt University
Nashville, Tennessee, United States
DT

Dominique Tran

Clinical Research Assistant, Cancer and Blood Disorders Institute
Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, United States
JJ

Jennifer Jones

Clinical Research Assistant, Cancer and Blood Disorders Institute
Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, United States
VK

Vyas Kartha

Assistant Professor, Anesthesia and Critical Care
Johns Hopkins All Childrens Hospital
Saint Petersburg, Florida, United States
NH

Nibal Harb

Manager, Blood Bank
Johns Hopkins All Children’s Hospital
Saint Petersburg, Florida, United States
Neil Goldenberg, MD,PhD

Departments of Pediatrics and Medicine
Johns Hopkins University School of Medicine, Baltimore, MD; Clinical and Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
Saint Petersburg, Florida, United States
Vera Ignjatovic, PhD, MBA

Professor of Pediatrics
Johns Hopkins All Children's Institute for Clinical and Translational Research; Department of Pediatrics, School of Medicine, Johns Hopkins University, United States
St Petersburg, Florida, United States

Presenting Author(s)

ND

NHUE DO

Surgical Director, Pediatric Heart Transplant and Ventricular Assist Device Program
Vanderbilt University
Nashville, Tennessee, United States

Background: Children undergoing cardiac surgery are at risk of bleeding. Prior studies on the benefits of cold stored-fresh whole blood (CS-FWB) in pediatric cardiac surgery has been inconclusive.

Aims: To evaluate blood product requirements and donor exposure in pediatric patients undergoing cardiac surgery who received CS-FWB( < 48-hours-old) compared to conventional component blood (CB) therapy.

Methods: This was an IRB-approved single-center retrospective study from January 2018 through October 2018. Patients < 18-years-old were included. Data was collected using the institution’s blood bank records and medical charts. Variables included: intraoperative and postoperative hematological indices, blood product usage, hospital length of stay, acute kidney injury, wound infection, and survival to discharge. Data analysis was conducted using descriptive variables.

Results: Fifty-seven patients (30 CS-FWB, 27 CB) met eligibility criteria. Patient demographics were similar, although CB patients were cooled to a lower intra-op temperature (p=0.03) (Table 1). No significant differences in blood product requirements were found from 24-hour to 7 days post-op. Patients with additional donor exposures in the CS-FWB group and CB group were 12 (40%) and 25 (92.6%), p<.001, respectively. Five CS-FWB patients received an additional aliquot from the same FWB donor they were exposed to during surgery. Compared to the CB group, CS-FWB patients at 24-hours post-op had higher median hemoglobin (13.3 vs. 12.1g/dL, p=0.03), and lower median platelets (113 vs. 175x103/mcl, p<.001). There was no difference in antifibrinolytics use, length of stay, sepsis, acute kidney injury, or wound infection. Survival to discharge was 100% and 96.3% in the CS-FWB and CB groups, respectively.

Conclusion(s): CS-FWB utilization in pediatric cardiac surgery may offer some benefit for donor exposure, hemostatic balance, and preserved platelet function despite a lower platelet count. Future multi-center prospective studies are needed to validate these findings, evaluate cold stored whole blood platelets, and patients who would benefit from FWB in pediatric cardiac surgery.