Viscoelastic testing in pediatric patients

Area of Science:

• Pediatric Hematology
• Transfusion Medicine
• Critical Care

Background:

• Current bleeding management guidelines for neonates and children often extrapolate from adult data due to limited pediatric evidence.
• Viscoelastic testing (VET) offers a point-of-care method for assessing hemostasis, but its application in pediatrics is less established.
• Hemostasis maturation continues through the first year of life, complicating the direct application of adult reference ranges.

Purpose of the Study:

• To provide a structured overview of published literature on using viscoelastic testing (VET) to guide bleeding management in neonates and children.
• To evaluate the feasibility and impact of VET-based transfusion algorithms in pediatric populations.
• To summarize current evidence on VET device availability and reference range establishment for pediatric use.

Main Methods:

• Systematic review of published studies on VET in pediatric bleeding management.
• Analysis of studies correlating VET results with standard laboratory tests and bleeding prediction.
• Evaluation of clinical trials implementing VET-guided transfusion algorithms in pediatric cardiac surgery.

Main Results:

• Limited pediatric-specific reference ranges exist for most VET devices.
• Adult reference ranges may be applicable for children over one year of age.
• Studies show VET can predict bleeding and detect coagulation disorders; implementation in pediatric cardiac surgery reduced transfusion requirements.

Conclusions:

• Viscoelastic testing-guided transfusion algorithms are a feasible and beneficial approach for managing bleeding in children.
• This strategy improves bleeding management and rationalizes blood product use in pediatric patients.
• Further research is needed, but VET shows promise for optimizing hemostasis management in young patients.