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Management of acquired coagulopathy in acute paediatrics
1NHS Blood and Transplant and Cambridge University Hospitals NHS Trust, Cambridge Blood Centre, Long Road, Cambridge CB2 0PT, UK. sarah.morley@nhsbt.nhs.uk
Insights
Acquired coagulopathy in children is rare but serious, often linked to critical illness. Diagnosis and treatment are complex due to developmental changes and limited tests, with plasma products remaining a key therapy.
Area of Science:
- Pediatric Hematology
- Critical Care Medicine
- Hemostasis and Thrombosis
Background:
- Acquired coagulopathy is uncommon in pediatric acute care but signifies severe underlying pathology and critical illness.
- Common causes include infection, hemorrhage, iatrogenic factors, and hepatic dysfunction.
- Coagulation is complex, interacts with other pathways, and undergoes significant developmental changes in early life.
Purpose of the Study:
- To review the etiology of acquired coagulopathy in acutely ill children.
- To describe available diagnostic tests for pediatric coagulopathy.
- To outline evidence-based treatment guidelines for pediatric acquired coagulopathy.
Main Methods:
- Literature review of acquired coagulopathy in pediatric acute care.
- Analysis of diagnostic tools and their limitations in children.
- Evaluation of current treatment strategies, including plasma products and newer agents.
Main Results:
- Acquired coagulopathy in children necessitates careful diagnosis considering age and development.
- Treatment primarily involves plasma products like fresh frozen plasma and cryoprecipitate.
- Despite advances, plasma product use is increasing, unlike other blood components.
Conclusions:
- Acquired coagulopathy in acutely ill children requires a thorough understanding of its causes and diagnostic challenges.
- Evidence-based treatment decisions are crucial, balancing risks and benefits of available therapies.
- Continued research is needed to optimize management strategies for pediatric coagulopathy.
Abstract:
Acquired coagulopathy is a relatively uncommon occurrence in acute paediatrics but when it occurs is usually associated with significant underlying pathology and often with critical illness. It can be caused by a number of disease processes but infection, blood loss, iatrogenic causes and liver dysfunction are among the commonest. The blood coagulation cascade is complex and intersects with many other physiological pathways. It is also subject to developmental changes, and 'normal' coagulation and haemostasis change considerably during early life. The diagnosis of abnormal coagulation and when treatment should be initiated is influenced both by age and developmental status and limited by the range of tests routinely available to clinicians. Treatment has predominantly involved transfusion of plasma products (usually fresh frozen plasma and cryoprecipitate) but a number of pharmaceutical and human-derived options are now available. Although plasma products are less frequently transfused than red cells or platelets, their use continues to increase and has not followed the reducing usage of other blood components. This article discusses the aetiology of coagulopathy, describes the commonly available diagnostic tests and outlines the evidence available to guide paediatricians when treating acutely ill children with acquired coagulopathy.
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