Correspondence

Pump Priming in Heart Surgery in Infants

N Engl J Med 2005; 352:731February 17, 2005

Article

To the Editor:

Mou and associates (Oct. 14 issue)1 report that the use of fresh whole blood for pump priming in cardiopulmonary bypass surgery in infants had no advantage over the use of reconstituted whole blood (a combination of red cells and fresh-frozen plasma). Indeed, priming with fresh whole blood was associated with an increased time in the intensive care unit and fluid overload. Since products from two donors were required to prepare reconstituted whole blood, the use of fresh whole blood reduced donor exposure. The authors suggest the extra exposure associated with reconstituted whole blood could be eliminated with the use of products from a single donor.

In a feasibility study involving a community blood center and a children's hospital, we demonstrated that it is logistically possible to provide matching units of red cells and fresh-frozen plasma from the same donor.2 Over a three-month period, we saved 132 exposures for 106 patients, including, but not limited to, patients undergoing cardiopulmonary bypass surgery. This program is ongoing. During the first six months of 2004, 81 of 83 open-heart operations with a primed cardiopulmonary pump in infants were carried out with red cells and fresh-frozen plasma from a single donor; the total additional cost for the fresh-frozen plasma was $2,884. In the cases in which the red cells and the fresh-frozen plasma were not from a single donor, the patients' blood type was AB and the fresh-frozen plasma was not compatible.

Marilyn S. Hamilton, M.D., Ph.D.
Children's Mercy Hospital, Kansas City, MO 64108
mhamilton@cmh.edu

Jay E. Menitove, M.D.
Community Blood Center of Greater Kansas City, Kansas City, MO 64111

2 References

1. 1

   Mou SS, Giroir BP, Molitor-Kirsch EA, et al. Fresh whole blood versus reconstituted blood for pump priming in heart surgery in infants. N Engl J Med 2004;351:1635-1644
   Full Text | Web of Science | Medline

2. 2

   Hamilton MS, Menitove JE, Buckley S, Peck K, Parton P. Limitation of donor exposures by transfusing PRBC and FFP from the same donor: a feasibility study at a children's hospital. Transfusion 2002;42:Suppl:135s-135s abstract.
   CrossRef | Web of Science

Citing Articles (1)

Citing Articles

1. 1

   Benjamin J. Pieters, Jennifer Weiford. (2011) Reduction in donor exposure with use of reconstituted blood in craniofacial patients - an alternative explanation. Pediatric Anesthesia 21:6, 710-711
   CrossRef