Thromboelastography-targeted management of severe coagulopathy and off-label use of four-factor prothrombin complex...

Area of Science:

• Pediatric critical care medicine
• Hematology
• Infectious diseases

Background:

• A 4-month-old infant presented with multiorgan failure and cerebellar hemorrhage due to disseminated enteroviral infection.
• The patient required listing for liver transplant due to the severity of the illness.

Observation:

• Severe coagulopathy developed, leading to a hemothorax after central line placement.
• Massive bleeding persisted despite surgical intervention and recombinant factor VIIa administration.

Findings:

• Bleeding was successfully controlled using thromboelastography-guided transfusion of platelets and cryoprecipitate.
• Administration of four-factor prothrombin complex concentrate was also crucial in achieving hemostasis.

Implications:

• This case highlights the effectiveness of a thromboelastography-guided transfusion strategy in managing severe, iatrogenic bleeding in critically ill infants.
• The findings underscore the importance of advanced coagulation monitoring and targeted therapy in pediatric critical care.