Indications for and strategies to reduce blood transfusion for craniosynostosis surgery: a narrative review.

Surgical correction of craniosynostosis has historically been associated with substantial intraoperative blood loss. Given that these procedures are often performed on infants, even small amounts of blood loss can have serious clinical consequences. To mitigate this risk, patients younger than one year frequently receive perioperative blood transfusions. However, a better understanding of the risk profile of blood product transfusions in the modern era has affected indications for and rates of transfusion done in association with craniosynostosis surgery. In addition, the development of minimally invasive techniques that reduce incision size, operative time, and blood loss have facilitated a lower frequency of transfusions. Another strategy is the use of pharmacological agents such as antifibrinolytics (e.g., tranexamic acid, fibrinogen concentrate, aminocaproic acid) and recombinant erythropoietin. Blood cell salvage and autologous transfusion is yet another means of avoiding allogenic blood transfusions. This narrative review examines the most recent literature to summarize indications for and strategies to reduce blood transfusion in craniosynostosis surgery. We also provide recommendations for which areas exhibit the highest need for additional high-powered controlled studies, the results of which would be practice-changing.