Investigating the value of routine pretransfusion testing prior to laparoscopic surgery in a paediatric population
Mikaela Lantz, Marie Andersson, Pia Löfgren, Josefin Nordenström, Cecilia Pardi, Sofia SjöströmAbstract
Introduction
Pretransfusion testing for determining ABO-type, RhD-status and screening for irregular red cell antibodies are frequently part of preoperative routines in paediatric surgery, regardless of low risk of bleeding complications related to laparoscopic procedures. The aim of this study was to evaluate if routine pretransfusion testing prior to paediatric laparoscopic surgery is motivated or if targeted testing could improve the use of resources without jeopardizing patient safety.
Methods
A single-centre, retrospective journal study included data from patients aged<18 who underwent laparoscopic surgery during 2019–2023. Data regarding surgical procedure, transfusion, relevant comorbidity and demographics were collected.
Results
During the five-year period 1191 laparoscopic procedures (608 (54%) acute and 511 (46%) elective) were carried out at median age 9.49 years (range 0.01–18) in 779 (65%) male and 412 (35%) female patients. In total fifteen patients (1.3%) required RBC transfusion perioperatively, five patients (0.42%) preoperatively, and six patients (0.50%) during postoperative care. Four patients (0.34%) received RBC transfusion intraoperatively and out of them, merely one (0.08%) received emergency and unexpected RBC transfusion. Irregular antibodies were found in 8 (0.7%) patients and none of them required RBC transfusion.
Discussion
The frequency of RBC transfusion during or after laparoscopic surgery in children and adolescents are remarkably low and generally predictable. Patients with increased risk of requiring RBC transfusion should continue to be subject to pretransfusion testing. Nevertheless, for most patients, routine pretransfusion testing can be omitted without jeopardizing patient safety and thereby improving utilization of resources.