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Perioperative paediatric patient blood management: a narrative review
Susan M Goobie1, David Faraoni2
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Patient blood management (PBM) improves care by treating anaemia and bleeding. Paediatric PBM, though challenging, offers significant benefits for surgical patients.
Area of Science:
- * Anesthesiology and Perioperative Medicine
- * Hematology and Transfusion Medicine
Background:
- * Patient blood management (PBM) is a multimodal, evidence-based approach to optimize patient outcomes by managing anaemia, coagulopathy, and blood loss.
- * While recommended for adults, PBM is not yet standard care in paediatric populations due to limited data and unique physiological challenges.
- * Paediatric PBM requires tailored strategies considering age, weight, and physiology across neonates, infants, children, and adolescents.
Purpose of the Study:
- * To review the latest updates, benefits, and principles of PBM in paediatric surgical populations.
- * To outline expert consensus guidelines and multimodal therapeutic strategies for managing paediatric anaemia, bleeding, and coagulopathies.
- * To highlight practical perioperative PBM strategies for paediatric patients.
Main Methods:
- * This narrative review synthesizes current literature and expert consensus on paediatric patient blood management.
- * Focuses on multimodal strategies including preoperative anaemia treatment, restrictive transfusion thresholds, antifibrinolytics, cell salvage, and goal-directed therapy.
- * Emphasizes the use of point-of-care and viscoelastic testing for informed clinical decisions.
Main Results:
- * Paediatric PBM is crucial for improving clinical care and patient outcomes in surgical settings.
- * Multimodal PBM strategies are effective in managing anaemia and minimizing bleeding in children.
- * Specific PBM interventions can optimize perioperative management for anaemic, bleeding, or coagulopathic paediatric patients.
Conclusions:
- * Paediatric patient blood management is essential for optimizing care in surgical populations.
- * Implementing evidence-based PBM strategies can significantly improve outcomes and reduce transfusion needs in children.
- * Further research and adoption of PBM are recommended to establish it as a standard of care for paediatric patients.
Abstract:
Patient blood management (PBM) encompasses implementing multimodal evidence-based strategies to screen, diagnose, and properly treat anaemia and coagulopathies using goal-directed therapy while minimising bleeding. The aim of PBM is to improve clinical care and patient outcomes while managing patients with potential or ongoing critical anaemia, clinically significant bleeding, and coagulopathies. The focus of PBM is patient-centred rather than transfusion-centred. Multimodal PBM strategies are now recommended by international organisations, including the World Health Organization, as a new standard of care and a proven means to safely and effectively manage anaemia and blood loss while minimising unnecessary blood transfusion. Compared with adult PBM, paediatric PBM is currently not routinely accepted as a standard of care. This is partly because of the paucity of robust data on paediatric patient PBM. Managing paediatric bleeding and blood product transfusion presents unique challenges. Neonates, infants, children, and adolescents each have specific considerations based on age, weight, physiology, and pharmacology. This narrative review covers the latest updates for PBM in paediatric surgical populations including the benefits and principles of paediatric PBM, current expert consensus guidelines, and important universal multimodal therapeutic strategies emphasising clinical management of the anaemic, bleeding, or coagulopathic paediatric patient in the perioperative period. Practical paediatric rules for PBM in the perioperative period are highlighted, with review of specific PBM strategies including treatment of preoperative anaemia, restrictive transfusion thresholds, antifibrinolytic agents, cell salvage, standardised transfusion algorithms, and goal-directed therapy based on point-of-care and viscoelastic testing.
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