PURPOSE Assess the effect of a protocol of preoperative erythropoietin (EPO) and ferrous sulfate in addition to perioperative tranexamic acid (TXA) on blood transfusions in patients with coronal or metopic craniosynostosis undergoing cranial vault remodeling (CVR) with fronto-orbital advancement (FOA). METHODS Retrospective review of all coronal and metopic craniosynostosis patients undergoing CVR and FOA from March 2010 to June 2019 was performed. Before 2014 ("Control group"), all patients received blood transfusion at the start of surgery. In 2014, a protocol of preoperative EPO and ferrous sulfate with perioperative TXA and non-automatic transfusion was instituted ("Study group"). Patient demographics and anthropometrics, perioperative hemoglobin (Hb) levels, and transfusion details were collected and compared. RESULTS Thirty-six patients met inclusion criteria. Twenty-one patients were in the control group, and 15 in the Study group. Nineteen patients had metopic synostosis, 11 had unicoronal synostosis, and 6 had bicoronal synostosis. There were no significant differences between groups in demographics, operative time, intraoperative crystalloid volume, craniofacial syndromes, or sutures affected. The Study group had higher preoperative Hb (13.9 ± 1.0 vs. 12.6 ± 0.8 g/dL, p < 0.001), lower intraoperative Hb nadir (7.4 ± 1.8 vs. 9.2 ± 1.2 g/dL) lower intraoperative transfusion rate (66.7% vs. 100%, p = 0.008), lower postoperative transfusion rate (0% vs 28.6%, p = 0.03), and exposure to fewer unique units of packed red blood cells (0.7 ± 0.6 vs. 1.5 ± 0.9 units). CONCLUSION Our protocol resulted in decreased transfusion needs. These results add valuable information to the growing body of work on transfusion reduction in craniosynostosis surgery.

中文翻译：

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视情况而定的输血、促红细胞生成素和氨甲环酸的方案减少了额眶前移中的输血，以治疗睑板和冠状颅缝早闭。

目的 评估术前促红细胞生成素 (EPO) 和硫酸亚铁方案以及围手术期氨甲环酸 (TXA) 对接受额眶前移 (FOA) 颅穹窿重塑 (CVR) 的冠状或近位颅缝早闭患者输血的影响. 方法对2010年3月至2019年6月接受CVR和FOA的所有冠状位和近位颅缝早闭患者进行回顾性分析。2014年之前（“对照组”），所有患者在手术开始时接受输血。2014 年，制定了术前 EPO 和硫酸亚铁联合围手术期 TXA 和非自动输血的方案（“研究组”）。收集并比较患者人口统计学和人体测量学、围手术期血红蛋白 (Hb) 水平和输血细节。结果 36 名患者符合纳入标准。对照组21人，研究组15人。19 例患者有中位骨性骨，11 人有单冠状骨骨性骨肉病，6 人有双冠状骨骨肉性骨肉病。在人口统计学、手术时间、术中晶体体积、颅面综合征或受影响的缝线方面，各组之间没有显着差异。研究组术前 Hb 较高（13.9 ± 1.0 vs. 12.6 ± 0.8 g/dL，p < 0.001），术中 Hb 最低点（7.4 ± 1.8 vs. 9.2 ± 1.2 g/dL）较低（66.7% vs. . 100%, p = 0.008)，较低的术后输血率 (0% vs 28.6%, p = 0.03)，以及接触较少独特单位的浓缩红细胞 (0.7 ± 0.6 vs. 1.5 ± 0.9 个单位)。结论 我们的方案导致输血需求减少。