Wirte an abstract for a research project Analysing blood transfusion in cranial vault reconstructive surgery for craniosynostosis . This is a bit more information about the potential research project and a pdf explaining it.
This study will look at the blood transfusions we give to our children and young people who have surgery to correct their head shape because they have a condition called craniosynostosis (cray-nee-o-sin-oss-toe-sis). When our patients have this surgery they are put asleep. The craniofacial surgeon cuts the scalp to be able to get to the bones of the skull to perform the surgery. The scalp is very vascular, which means it has lots of tiny blood vessels which can cause a lot of bleeding, so they may be given a blood transfusion while they are asleep in surgery or shortly afterwards.
Our study will look at our information for the last 5 years for the patients who have had this surgery and see how much blood transfusions they have needed. All our patients have two units of blood ready for them in case it is needed during this type of surgery. This involves taking blood samples to find out the blood group of the patient before their surgery. The staff in the blood transfusion laboratory analyse the sample and order the best match blood so it is available. A lot of the time in surgery, we only use one unit of blood and the other unit is not used but because it is ready for that patient it cannot be given to anyone else at that time. This does mean that somewhere else in this hospital or another hospital that someone else needs a unit of blood which is that particular blood group.
We will look to see if there are some patients having surgery that we should only prepare one unit of blood for as some blood groups are in high demand. If anything changes during the surgery the patient will be kept safe and they will always be given a unit of blood if they need it as there is also “emergency blood” available in the blood transfusion laboratory. We have a responsibility to manage our blood stocks efficiently and ensure that the units of blood we hold in the hospital are the correct number and type. We will look at the information and see if we should change what we currently do for our future patients while making sure they are always kept safe and receive the best care.
B4. Provide brief information on the study background.
Craniosynostosis is the premature fusion of one or more cranial sutures resulting in abnormal skull growth pattern which if left untreated can result in raised intracranial pressure due to insufficient space for brain growth or functional issues with eyesight, breathing, speech and development. The treatment of choice is surgery which will correct the head shape. Typically, children will undergo cranial vault reconstructive surgery at less than 12 months of age, which allows for more effective bony remodeling, and the avoidance of these potential complications of raised intracranial pressure and impaired brain growth.1,2
Blood loss in craniosynostosis procedures can be significant, due to the high vascularity of the scalp and extradural tissues, and the larger proportion of the skull to total body surface area in young children.3 Patient blood management is based upon three ‘pillars’ of care; pre-operative identification of anaemia and optimisation of haemoglobin, intra-operative strategies to reduce blood loss and requirement for heterogeneous transfusion, and post-operative blood recovery support.4 Blood management research in craniosynostosis has focused largely upon the use of pre-operative erythropoietin, intra-operative anaesthetictechniques, cell-salvage and anti-fibrinolytics, and postoperative blood transfusion protocols.3
Currently at the NPCC every patient undergoing cranial vault reconstructive surgery is cross matched for two units of red blood cells (RBC) before surgery. Anecdotally there is usually only one unit of RBC transfused during surgery meaning that one of the two units cross matched to the patient for surgery does not get used. Having blood reserved and issued to a patient that is not likely going to use it, means the unit of RBC is unavailable to a patient that may need it either in this hospital or another hospital. This is particularly important for blood groups that are in high demand such as O Rh D negative units. We have a responsibility to manage our blood stocks efficiently and ensure that the units of RBC we hold on site is appropriate.
References:
1. Governale LS. Craniosynostosis. Pediatric Neurology. 2015;53(5):394-401.
2. Pagnoni M, Fadda MT, Spalice A, et al. Surgical timing of craniosynostosis: What to do and when. Journal of Cranio–‐Maxillofacial Surgery. 2014;42(5):513-519.
3. Hughes C, Thomas K, Johnson D, Das S. Anesthesia for surgery related to craniosynostosis: a review. Part 2. Paediatr Anaesth. 2013;23(1):22-27.
4. Goel R, Cushing MM, Tobian AA. Pediatric Patient Blood Management Programs: Not Just Transfusing Little Adults. Transfus Med Rev. 2016;30(4):235-241.
B5. List the study aims, design and objectives.
This review will analyse the blood transfusion requirements of these patients over a five-year period from 1st January 2017 to 31st December 2021 with particular emphasis on age at surgery, surgical procedure, subtype of craniosynostosis and/or presence of craniofacial syndrome, number of RBC transfused and at what time points and patient blood group.
The purpose of this review is to aid development of a multi-stakeholder blood transfusion management strategy which will include our colleagues in the Department of Anaesthesia with a view to rationalising the requirements to crossmatch two units of RBC for every patient undergoing cranial vault reconstructive surgeries at the NPCC.