[size=6]You are doing a nephrectomy and retroperitoneal lymph node sampling for a 3-year-old child with a large renal tumor. The preoperative hemoglobin was 8.2 g/dL and there has been minimal bleeding during the operation. The patient has been hemodynamically stable with a urine output of 1.8 ml/kg/hr. The anesthesiologist says the current hemoglobin is 6.9 g/dL. What would you recommend?

 

a Transfuse 10 ml/kg of packed red blood cells

 

b Administer erythropoietin postoperatively

 

c No packed red blood cell transfusion

 

d Transfuse 20 ml/kg of packed red blood cells[/size]

D

A

[b]correct answer

c No packed red blood cell transfusion

 

A red blood cell transfusion would not be appropriate in this scenario. While blood transfusions can be necessary and lifesaving in oncologic operations with bleeding, they are associated with long-term risks for inflammation and immunosuppression. Similar to findings in adults, Acker et al. found that packed red blood cell transfusions were associated with greater mortality, infection, and tumor recurrence in children who underwent resections of solid tumors and a more rapid time to tumor recurrence. Furthermore, each successive unit of blood transfused was associated with increased risk for infection and death. Further studies are needed to confirm a role for erythropoietin for postoperative anemia in children with solid tumors.

 

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