Department of Surgery, Pediatric Surgery, University of Minnesota, 2450 Riverside Ave S, East Building MB511, Minneapolis, MN 55454, USA.
Rotkreuzklinikum München, München, Germany.
J Pediatr Surg. 2021 Sep;56(9):1657-1660. doi: 10.1016/j.jpedsurg.2021.04.027. Epub 2021 May 2.
Thrombocytopenia is a common perioperative clinical problem and preoperative platelet transfusion prior to surgery is standard practice. Recent platelet trials and literature reviews have found no association between platelet count and bleeding incidence except when platelet count is extremely low. Our aim was to evaluate the bleeding risk and the overall platelet transfusion management among pediatric patients with severe thrombocytopenia based on whether they were preoperatively transfused versus transfused at time of incision.
This is a retrospective analysis of pediatric patients with a platelet count ≤50 × 10/L in the 12 h prior to surgery at a single tertiary pediatric hospital from 2011 to 2016. Eligible patients were ≤21 years old. Patients with necrotizing enterocolitis and neonates were excluded. The primary outcome was postoperative bleeding complications. Additional outcomes were preoperative platelet change and weight adjusted transfusion volumes.
A total of 37 patients were included in this analysis of which 29 (78%) received preoperative platelet transfusions within 12 h prior to surgery. No postoperative bleeding complications occurred 30 days after operation, regardless of preoperative transfusion status. There was no significant difference in platelet change by preoperative transfusion status and preoperative transfusion volume was a poor predictor of change in preoperative platelet count (crude: r=0.19, age/gender adjusted: r=0.48).
Patients transfused at time of surgical procedure did not have an increased risk of bleeding over those preoperatively transfused. This finding is in agreement with previous studies in adult populations, supporting the safety of deferring platelet transfusions until the time of incision for thrombocytopenic pediatric surgical patients.
III.
血小板减少症是一种常见的围手术期临床问题，手术前输注血小板是标准做法。最近的血小板试验和文献综述发现，血小板计数与出血发生率之间没有关联，除非血小板计数极低。我们的目的是评估严重血小板减少症的儿科患者在手术前与手术时输注血小板之间的出血风险和整体血小板输注管理。
这是对 2011 年至 2016 年期间一家三级儿科医院术前 12 小时血小板计数≤50×10/L 的儿科患者进行的回顾性分析。符合条件的患者年龄≤21 岁。排除患有坏死性小肠结肠炎和新生儿的患者。主要结局是术后出血并发症。其他结局是术前血小板变化和体重调整的输血量。
共有 37 例患者纳入本分析，其中 29 例（78%）在手术前 12 小时内接受了术前血小板输注。术后 30 天无论术前输血状态如何，均未发生术后出血并发症。术前输血状态与血小板变化无显著差异，术前输血量不能很好地预测术前血小板计数的变化（未校正：r=0.19，年龄/性别校正：r=0.48）。
手术时输注的患者与术前输注的患者相比，出血风险没有增加。这一发现与以前在成人人群中的研究一致，支持对血小板减少症的儿科手术患者推迟到手术时再输注血小板的安全性。
III。
