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Sofia Gouveia1, André Caiado2, Sara Ramos3, Ana Margarida Ferreira4, Deonilde Espírito-Santo5

1- Interno Imunohemoterapia, Hospital C.Cabral. Centro Hospitalar Lisboa Central
2- Interno Imunohemoterapia, Hospital São José. Centro Hospitalar Lisboa Central.
3-Assistente Hospitalar, Anestesiologia, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central
4- Interno Anestesiologia, Hospital São José. Centro Hospitalar Lisboa Central
5- Assistente Graduado Sénior, Imunohemoterapia, Centro Hospitalar Lisboa Central

- Nata, Network for the Advancement of Patient Blood Management, Haemostasis nd Thrombosis. 17th Annual Symposium, Dublin, Republic of Ireland, April 14-15, 2016

Introdução: Scoliosis affects 2-4% of children under 18 years of age. Scoliosis surgery aims to stop the progression of the disease, avoid worsening of respiratory and cardiac function, improve quality of life and physical appearance, but may result in major blood loss (up to 280 ml per vertebral level in neuromuscular scoliosis). Before 2014, these patients were operated without any special Patient Blood Management (PBM) strategy. During the 2nd semester of 2015, one month before surgery, all patients were screened for anemia, and optimized in order to reduce intraoperatory blood loss.
Objetivo: The results obtained lead us to develop a multidisciplinary blood management protocol in pediatric scoliosis surgery, with the aim of standardizing care, minimizing blood transfusion requirements and reducing complications, to be implemented from January 1st 2016.
Métodos: Five weeks before the surgery, all patient are evaluated with a complete clinical history, directed to determination of thrombotic and haemorrhagic risk, pre-operative evaluation of haemoglobin and iron metabolism status, study of coagulation disorders and their optimization when needed. All patients with anaemia or low iron deposits will be treated with oral or IV iron, according to the severity of the disease. Folic acid or cobalamin deficiency will be sought out and corrected. Before the beginning of surgery, a complete blood count (CBC) and coagulation study with fibrinogen is performed. When there is a history of haemorrhagic disorder, higher bleeding risk, the initial lab tests reveal altered coagulation profile or fibrinogen level below 2 g/dL, a thromboelastogram is also performed and used for guided hemostatic therapy. Tranexamic acid is administrated to all patients (loading dose of 20 mg/kg followed by infusion of 10 mg/kg/hour) and Cell Saver is used for children weighting above 10 Kg and expected blood loss exceeding 20% volemia. Further analytical control should be performed at the end of surgery and after five days.
Resultados Comparing standard surgical blood order (SSBO) in scoliosis surgeries between 2013-14 and the 2nd semester of 2015, we obtained a substancial reduction in transfusional requirements.
Conclusões: With the implementation of this protocol, we expect to further reduce blood loss and blood component transfusion, length of stay and post-operative complications.

Palavras Chave: Patient Blood Management, Pediatric Scoliosis surgery.