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RISK FACTORS RELATED TO BLOOD COMPONENT TRANSFUSION IN CHILDREN UNDERGOING SURGICAL RESECTION OF INTRACRANIAL TUMORS

Grant number: 23/00234-3
Support Opportunities:Scholarships in Brazil - Scientific Initiation
Effective date (Start): March 01, 2023
Effective date (End): February 29, 2024
Field of knowledge:Health Sciences - Medicine - Surgery
Principal Investigator:Marcos Devanir Silva da Costa
Grantee:Carolina Torres Soares
Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

The central nervous system demands much of the body's cardiac output and energy metabolism. Thus, massive blood loss can reduce brain tissue perfusion and, therefore, are associated with higher mortality and neurological damage. During neurosurgical procedures in children and adolescents, bleeding is one of the most common complications - both due to dysfunctions caused by the disease and due to characteristics of the immature organism facing a complex procedure. Thus, there is a significant risk of perioperative hemorrhage and progression to hypovolemia, coagulopathies, electrolyte disturbances, hypothermia and longer stays in Intensive Care Units.Therefore, , the transfusion of blood components plays a fundamental role in the medical history, having been able to change the evolution of many patients, with rapid reversal of potentially fatal conditions, such as hypovolemia or critical hemoglobin levels. However, despite all the advances in the collection, storage and use chain of blood components, the risks associated with transfusion are still significant - such as acute lung injury, hemolytic reactions, allergic reactions, hypervolemia and allogeneic immunomodulation.According to large studies, an important part of pediatric patients who receive transfusions are cancer patients, reaching 39%. In this scenario, CNS tumors stand out in prevalence and especially among red blood cell transfusions.However, little has been clarified regarding transfusions in pediatric cancer patients - there is still no consensus regarding the indicative thresholds for transfusion, with different levels being adopted in each institution.Our study aims to evaluate the risk factors for blood transfusion in patients under 18 years of age undergoing resection surgery for central nervous system tumors at the Pediatric Oncology Institute/GRAACC-UNIFESP. We will analyze the incidence and correlation of blood transfusions with laboratory data, tumor characteristics, patient profile and duration of surgeries.A retrospective analysis of the medical records and files of all patients under 18 years of age who underwent neurosurgery for tumor resection in the service between 2017 and 2022 at IOP/GRAACC-UNIFESP will be performed. Data collected will include patient age and sex, histological type, topography and volume of the tumor, pre- and intraoperative laboratory tests, duration of surgery, time of transfusion and transfused blood component.Data analysis and graph creation will be performed with the GraphPad Prism 8 software, based on the mathematical tests Logrank Mantel-Cox or Logrank test for trend. Qualitative variables will be analyzed by contingency tests, using Fisher's exact test. Significance will be considered for an ± less than or equal to 0.05.In addition to approval by the ethics and research committee, the patients' identities will be kept confidential, through numerical and random standardization of the medical records, omitting the identification of individuals. Patients and their legal guardians must authorize their participation in the study by signing the informed consent form. Patients who have died or who cannot be contacted directly or by telephone will be exempt from signing the term. In addition, a TERM OF COMMITMENT FOR THE USE OF DATA was drawn up, signed by the research researchers for cases in which it will not be possible to obtain the informed consent form.

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