The vast majority of infants and children undergoing
craniosynostosis correction receive a
blood transfusion. The risks of
blood transfusion include, but are not limited to, acute hemolytic reactions (approximately 1 of 250,000), human immunodeficiency virus (approximately 1 of 200,000),
hepatitis B and C (approximately 1 of 30,000 each), and transfusion-related
lung injuries (approximately 1 of 5000). This prospective, single-blinded, randomized study was undertaken to examine the safety and efficacy of preoperative single weekly dosing with
erythropoietin (
epoetin alfa) in reducing the rate of transfusion in infants and small children undergoing
craniosynostosis repair. A total of 29 patients (<8 years) undergoing
craniosynostosis repair were randomized into two groups: one received preoperative
erythropoietin (600 U/kg) weekly for 3 weeks, and the other served as a control. All caregivers responsible for
blood transfusions were blinded, and strict criteria for transfusion were established. A pediatric hematologist monitored both groups, and all patients received supplemental
iron (4 mg/kg). Fourteen patients were randomized to receive
erythropoietin, and eight of these 14 patients (57 percent) required transfusion (mean age, 17 months; mean weight, 10.1 kg). Of the six patients not requiring transfusion, three were younger than 12 months old (mean, 6 months). Fourteen of 15 patients (93 percent) in the control group (mean age, 13 months; mean weight, 9.3 kg) required a
blood transfusion during the study. The only control patient not requiring transfusion was the eldest (5 years old). The difference between the two groups was statistically significant (Fisher's exact test = 0.03). The control group showed no change in
hemoglobin levels from baseline to preoperative levels, but the
erythropoietin group increased their average
hemoglobin levels from 12.1 to 13.1 g/dl. There were no adverse effects noted among children receiving
erythropoietin, nor were there any surgical complications. The authors conclude that the preoperative administration of
erythropoietin significantly raised
hemoglobin levels and reduced the need for a
blood transfusion with
craniosynostosis correction. More suggestions are made that may further reduce the need for
blood transfusions, and a cost-benefit analysis is discussed.