Massive blood loss during highly traumatic surgical intervention in pediatric oncology (clinical case)

Introduction. Massive perioperative blood loss that accompanies major surgical interventions is a specific critical condition, the  pathogenesis of which is dominated by severe hypovolemia, anemia, and threatening coagulopathy in combination with powerful shockogenic sympathoadrenal stress. Both massive blood loss itself and massive transfusion are associated with a significant risk of serious complications, including death. It is worth noting that information on the survival of patients after replacement of several circulating blood volume (CBV) is limited, and most of the articles are devoted to adult patients with highly traumatic surgical interventions.

The objective was to present the experience in managing the patient with blood loss of more than 5.5 CBV according to the MT protocol adopted at the Research Institute of Pediatric Oncology and Hematology. The 3-year-old patient underwent surgical intervention in the following volume: median laparotomy, nephradrenalectomy on the right (lesion 10–15–20 cm in size), paracaval and aortocaval lymph node dissection (conglomerate 7–8 cm in size), resection of S5-S6-S7 liver segments, resection of the right domes of the diaphragm. During the surgical  intervention of 440 minutes (7.3 hours), the total blood loss was 5.5 CBV (5.500 ml).

Results. After surgery, he was transferred to prolonged assisted ventilation of the lungs, the duration of which was 2 days. On the 3^rd day after the operation, adjuvant polychemotherapy was started. 17 days after the operation, the patient was transferred to the specialized department for further treatment. The patient was alive for a year after surgery.

Conclusion. Maintenance of homeostasis, normothermia, normocoagulation through basic infusion therapy with balanced crystalloid solutions, targeted transfusion therapy with the introduction of fresh frozen plasma, transfusion of donor platelets and donor  erythrocytes/autoerythrocytes during anesthesia in the child with extremely massive blood loss, contributed to early post-anesthetic rehabilitation,  provided the opportunity to continue special treatment in the intensive care unit.

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