Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000200015
Brazilian Journal of Anesthesiology
Review Article

Transfusão sangüínea em crianças e os métodos para evitá-la: uma reavaliação

Blood transfusion in pediatric patients and strategies to decrease it: a reevaluation

Mário José da Conceição

http://dx.doi.org/10.1590/S0034-70942004000200015 Braz J Anesthesiol, vol.54, n2, p.276-282, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: Muitas medidas e técnicas são utilizadas, nos pacientes adultos, na tentativa de reduzir, ou evitar, tanto a perda sangüínea como a administração de sangue homólogo durante atos cirúrgicos para os quais se esperam grandes perdas na volemia. Enquanto as estratégias para evitar a utilização de sangue homólogo em pacientes adultos são largamente empregadas, nos pacientes pediátricos são negligenciadas. Talvez isso se deva ao fato de que em crianças essas técnicas podem não ser tão úteis quanto nos adultos, além dos problemas técnicos próprios do tamanho dos pacientes. O objetivo dessa revisão foi reavaliar as técnicas para reduzir a necessidade de transfusão de sangue homólogo em adultos e discutir sua utilização em pacientes pediátricos. CONTEÚDO: Através da pesquisa bibliográfica apresentam-se às estratégias mais freqüentes para diminuir, ou mesmo evitar, transfusão de sangue homólogo durante atos cirúrgicos nos quais esperam-se grandes perdas volêmicas. Como todos os métodos conhecidos foram desenvolvidos para pacientes adultos, projeta-se, a partir daí, reavaliando-se esses métodos, técnicas e fármacos, uma linha de ação visando a sua aplicabilidade nos pacientes pediátricos. CONCLUSÕES: Mais uma vez fica patente que as soluções obtidas para adultos não são aplicáveis inteiramente aos pacientes pediátricos. As medidas para reduzir o sangramento intra-operatório e a conseqüente redução na necessidade do emprego de sangue homólogo são eficientes em pacientes adultos, porém são de longe mais invasivas, complicadas e muitas delas ineficientes nos pacientes pediátricos, notadamente naqueles abaixo de dois anos de idade.

Palavras-chave

ANESTESIA, DROGAS, SANGUE, SANGUE

Abstract

BACKGROUND AND OBJECTIVES: Several approaches and techniques are used in adult patients to decrease or prevent both blood loss and homologous blood transfusion during surgical procedures where massive blood losses are expected. While these blood-sparing strategies are widely used in adults, they are mostly neglected in children. Perhaps in pediatric patients, these blood-sparing techniques may not be as effective as in adults and technical limitations, as the small size of patients could limit its advantages. In the following review, blood-sparing techniques established for adults are described and their applicability in pediatric patients discussed. CONTENTS: Blood-sparing strategies developed for adult patients aiming at decreasing or even preventing homologous blood transfusion when massive blood losses are expected, are presented through a bibliographic review. Since all known methods were developed for adult patients, an action line was drawn for the reevaluation of these methods, techniques and drugs to be used in pediatric patients. CONCLUSIONS: It has become once more clear that solutions for adult patients may not be as effective for pediatric patients. Intraoperative blood-sparing techniques and consequent decrease in the need for homologous blood are effective for adult patients but are by far more invasive, complicated, and some of them ineffective in pediatric patients, especially those under two years of age.

Keywords

ANESTHESIA, BLOOD, BLOOD, DRUGS

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