ORIGINAL RESEARCH article
Front. Anesthesiol.
Sec. Perioperative Medicine
This article is part of the Research TopicPerioperative Optimization and Perioperative Medicine: Optimizing Outcomes and Safety across Surgical CareView all 3 articles
An Institutional Review of Perioperative Outcomes in Pediatric Bone Marrow Donors. A Retrospective Study
Provisionally accepted
- 1St. Jude Children’s Research Hospital, Memphis, TN, United States
- 2Cleveland Clinic, Cleveland, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: During hematopoietic stem and progenitor cell collection from the bone marrow under anesthesia, pediatric donors are exposed to potential complications including hypotension, pain, blood transfusion, endotracheal intubation risks, prone positioning injuries, and postoperative nausea and vomiting (PONV). We evaluated the overall incidence and severity of adverse events to identify opportunities to improve perioperative outcomes for this unique population. Methods: With institutional review board approval, all donors under 18 years of age who had bone marrow harvest under general anesthesia between 2010 and 2024 at our institution were included in this retrospective study. Autologous donors and donors whose cells were collected by apheresis without anesthesia were excluded. Results: The study included 61 donors with a mean age of 9.62 years, mean donor/recipient weight ratio of 1.57, mean harvest volume of 14.2 mL/kg donor weight, and mean fasting duration for clear liquids and solids of 9.31 and 11.3 hours, respectively. Twenty-nine (47.5%) experienced at least 1 adverse event. 10 (16.4%) donors experienced at least 1 cardiovascular adverse event. Out of ten episodes of significant hypotension events, 4 donors required vasopressors intraoperatively, 2 experienced dizziness in the post-anesthesia care unit (PACU), and 4 experienced symptomatic hypotension after discharge from the PACU. One infant required blood product transfusion. ix donors (9.8%) experienced post-operative nausea vomiting (PONV), and 7 others (11.5%) experienced post-discharge vomiting. There was one overnight admission, 1 readmission, and 2 unanticipated visits. Conclusions: This single institution study highlights improvement opportunities for the perioperative care of pediatric bone marrow donors. We propose strategies to optimize preoperative fasting, intraoperative analgesia, and antiemetic prophylaxis and recommend a procedure-specific intravenous fluid replacement calculator, and admission and discharge criteria for bone marrow donors.
Keywords: Hematopoietic Stem Cells, general anesthesia, Child, Hypotension, Fasting, Postoperative Nausea and Vomiting, Patient Discharge
Received: 26 Sep 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Raghavan, Sweeney, Bi, Selukar, Triplet and Anghelescu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kavitha Raghavan, kavitha.raghavan@stjude.org
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.