Massive Transfusion of 5 U Packed Redblood Cells, 3 U Fresh Frozen Plasma, and 160 cc of Platelets in a 14-Month-Old Patient

Patient: Female, 1 Final Diagnosis: Parietooccipital brain tumor Symptoms: Drowsiness • failure to thrive • irritability • seizure-like activity Medication: — Clinical Procedure: Massive transfusion during tumor resection Specialty: Anesthesiology OBJECTIVE: Management of emergency care BACKGROUND: We present a case in which extremely rapid massive transfusion was successfully used to combat severe acute bleeding during a parietooccipital tumor resection in a 14-month-old patient. CASE REPORT: An 8-kg patient was found to have a 4×5×5-cm parietooccipital tumor on computed tomography scan, for which resection was urgently planned. Sudden acute bleeding was encountered, which was communicated to the anesthesia team. Transfusion was initiated and a total of 5 units of packed red blood cells, 3 units of fresh frozen plasma, 160 ml of platelets, 200 ml of albumin, and 500 ml of 0.9% normal saline were transfused during a 4-h period. We administered 4 g of mannitol and 0.8 mg of furosemide to deal with anticipated fluid overload. The patient was sent to the intensive care unit and extubated the next day. No clinically significant hemostatic or fluid overload complications were noted after the treatment. CONCLUSIONS: Massive transfusion (MT) was found to be safe and effective in this case. Most of what we know about pediatric MT is an extrapolation of data from adult studies. Although practical, it might not be ideal due to the differences in the physiology and incomplete development of hemostatic mechanisms in children, especially those younger than 12 months. Studies evaluating the use of pediatric MT protocols have not shown a significant advantage over transfusion per clinician discretion.