• Luisa Meneghini, Nicola Zadra, Vittorio Aneloni, Salvatore Metrangolo, Roberto Faggin, and Franca Giusti.
• Anesthesiology and Intensive Care Institute, Transfusion Medicine and Immune-Hematology and Pediatric Neurosurgery, University of Padua, Italy.
• Paediatr Anaesth. 2003 Jun 1; 13 (5): 392-6.

BackgroundA retrospective study was performed to evaluate whether pretreatment with erythropoietin and iron combined with acute preoperative normovolaemic haemodilution (APNH) could decrease homologous blood transfusion in craniosynostosis (CS) surgery. A treated group was compared with a historical group of infants who underwent surgery with no pretreatment.MethodsThe charts of 25 healthy infants who underwent CS surgery were reviewed. Nine of them underwent surgery with no treatment beforehand. Sixteen infants were given erythropoietin at a dosage of 300 U.kg -1 two times per week and iron (elemental iron 10 mg.kg-1.day-1) for 3 weeks before surgery. On the day of surgery APNH was performed after induction of general anaesthesia; a precalculated amount of autologous blood was withdrawn and replaced by hydroxyethyl starch 6%.ResultsEleven of the 16 infants of the study group received only autologous blood. Five of 16 received homologous blood transfusion vs seven of nine infants in the control group.ConclusionsAPNH combined with erythropoietin was effective in reducing homologous blood requirements during CS surgery. Further studies are necessary on a larger scale to assess the role of this technique in avoiding homologous blood transfusion and to evaluate how infants can benefit from this combined approach.

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