Massive transfusion in children and neonates

Area of Science:

• Pediatric critical care medicine
• Hematology
• Trauma surgery

Background:

• Severe bleeding in children and neonates, often from surgery or trauma, frequently necessitates massive transfusion (MT).
• Understanding of massive hemorrhage pathophysiology and MT's hemostatic effects has improved, influencing adult MT protocols (MTPs) towards early, balanced product transfusion.
• Limited pediatric data exists, contributing to institutional variability in managing pediatric massive bleeding.

Purpose of the Study:

• To review current concepts in massive bleeding and MT biology.
• To outline essential management principles and existing practices for pediatric massive transfusion.
• To highlight relevant adult and pediatric data concerning massive transfusion.

Main Methods:

• Literature review of recent studies on massive hemorrhage and transfusion.
• Analysis of current adult and pediatric massive transfusion protocols and guidelines.
• Synthesis of available data on pediatric massive transfusion outcomes.

Main Results:

• Recent research has enhanced understanding of massive hemorrhage and MT's impact on hemostasis.
• Adult MTPs emphasize early, balanced transfusion, but optimal pediatric approaches remain unclear.
• Significant variability exists in pediatric MT practices due to limited specific data.

Conclusions:

• Further research is needed to establish evidence-based pediatric massive transfusion protocols.
• Standardizing MTPs for children and neonates is crucial to improve outcomes in massive bleeding scenarios.
• Translating adult MTP principles to pediatrics requires careful consideration of unique physiological differences.