Bone marrow harvesting in children managed without allogenic blood

Abstract

Eleven children undergoing bone marrow harvesting were studied on 15 occasions to assess whether preoperative haemodilution and the acceptance of a transiently low haemoglobin concentration (5 g·dl−1) during anaesthesia, would obviate the need for giving allogenic blood. Before harvesting, 20 (8–28) ml·kg−1 of blood (median (range)) was collected in citrate‐phosphate‐dextrose (CPD) bags and replaced isovolaemically with dextran‐60 in Ringer's acetate. Replacement of the harvested volume (26 (17–42) ml·kg−1) was done with the same solution. The bag content was reinfused before awakening; red cells recovered during processing of the bone marrow 2–4 h postoperatively. The preoperative haemoglobin concentration (Hb) was 10.3 (8.7–12.3) g·dl−1 and central venous oxygen saturation (Scvo2) 82 (70–94)%. Hb decreased to 5.4 (4.7–8.4) g·dl−1 (P < 0.01) at the end of harvest, and Scvo2 to 76 (60–92)% (P < 0.05). Retransfusion from the CPD bags increased Hb to 6.8 (5.8–9.5) g·dl−1 (P < 0.05). After extubation Scvo2 decreased to 67 (55–79)% (P < 0.05). Reinfusing the harvested red cells increased Hb to 8.6 (6.6–10.5) g·dl−1 and Scvo2 to 74 (59–78)%. Hb one week after the harvest was 11.0 (7.4–12.7) g·dl−1. The authors conclude that the combination of preoperative and intraoperative haemodilution was well tolerated as judged from haemodynamics, Scvo2 and pH and allowed large volumes of bone marrow to be harvested without the need for allogenic blood.