Bleeding and thrombotic events are frequent complications seen in critically ill children. Bleeding is associated with longer hospital stays, longer duration of mechanical ventilation, and increased mortality. Multiple interventions, including notably plasma and platelet transfusions, are used to restore hemostasis. Thrombotic events are also associated with worse clinical outcomes. Antithrombotic therapies, including anticoagulation, are frequently used to mitigate these risks. However, both transfusions and anticoagulation are also independently associated with unfavorable outcomes. Therefore, the balance of hemostasis without thrombosis is a daily challenge in pediatric critical care.
The goal of this series is to describe the current hemostatic challenges that occur in critically ill children. We will address both bleeding and thrombotic events, as well as the prophylactic and therapeutic strategies used to alleviate these outcomes. We will address some specific conditions, such as extracorporeal life support, severe trauma, liver failure, and severe sepsis. We will describe current hemostatic tests, some newer assays, as well as the evidence for using whole blood and cold platelets.
Specific Themes:
• Bleeding in Critically Ill Children: definitions, epidemiology, knowledge gaps
• Thrombosis in Critically Ill Children: definitions, epidemiology, knowledge gaps
• Hemostatic Testing in Critically Ill Children: developmental hemostasis, overview of tests (platelet count, coagulation tests, platelet function tests, TEG/ROTEM, thrombin generation), new tests (Sonic Estimation of Elasticity via Resonance, etc.), reference ranges and quality issues
• Overview of Plasma Transfusions in Critically Ill Children: epidemiology, indications, products, adverse effects
• Overview of Platelet Transfusions in Critically Ill Children: epidemiology, indications, products, adverse effects
• Overview of Cryoprecipitate and Fibrinogen in Critically Ill Children: epidemiology, indications, products, controversies
• Hemostatic Balance in Severe Trauma: epidemiology of bleeding and thrombosis, indications (goal-directed therapy versus fixed ratio), current recommendations
• Hemostatic Balance on Extracorporeal Life Support: epidemiology of bleeding and thrombosis, associated outcomes, prophylactic and therapeutic hemostatic transfusions
• Hemostatic Balance in Acute Liver Failure: epidemiology of bleeding and thrombosis, physiology, current strategies
• Hemostatic Balance in Severe Sepsis: epidemiology of bleeding and thrombosis, physiology, current strategies
• Hemostatic Balance of the Critically Ill Oncology Patient: epidemiology of bleeding and thrombosis, physiology, current strategies
• Hemostatic Balance in Critically Ill Cardiac Patient: epidemiology of bleeding and thrombosis, physiology, current strategies
• Controversies around Whole Blood and Cold Platelet Transfusions: physiology, current evidence, future directions.
Bleeding and thrombotic events are frequent complications seen in critically ill children. Bleeding is associated with longer hospital stays, longer duration of mechanical ventilation, and increased mortality. Multiple interventions, including notably plasma and platelet transfusions, are used to restore hemostasis. Thrombotic events are also associated with worse clinical outcomes. Antithrombotic therapies, including anticoagulation, are frequently used to mitigate these risks. However, both transfusions and anticoagulation are also independently associated with unfavorable outcomes. Therefore, the balance of hemostasis without thrombosis is a daily challenge in pediatric critical care.
The goal of this series is to describe the current hemostatic challenges that occur in critically ill children. We will address both bleeding and thrombotic events, as well as the prophylactic and therapeutic strategies used to alleviate these outcomes. We will address some specific conditions, such as extracorporeal life support, severe trauma, liver failure, and severe sepsis. We will describe current hemostatic tests, some newer assays, as well as the evidence for using whole blood and cold platelets.
Specific Themes:
• Bleeding in Critically Ill Children: definitions, epidemiology, knowledge gaps
• Thrombosis in Critically Ill Children: definitions, epidemiology, knowledge gaps
• Hemostatic Testing in Critically Ill Children: developmental hemostasis, overview of tests (platelet count, coagulation tests, platelet function tests, TEG/ROTEM, thrombin generation), new tests (Sonic Estimation of Elasticity via Resonance, etc.), reference ranges and quality issues
• Overview of Plasma Transfusions in Critically Ill Children: epidemiology, indications, products, adverse effects
• Overview of Platelet Transfusions in Critically Ill Children: epidemiology, indications, products, adverse effects
• Overview of Cryoprecipitate and Fibrinogen in Critically Ill Children: epidemiology, indications, products, controversies
• Hemostatic Balance in Severe Trauma: epidemiology of bleeding and thrombosis, indications (goal-directed therapy versus fixed ratio), current recommendations
• Hemostatic Balance on Extracorporeal Life Support: epidemiology of bleeding and thrombosis, associated outcomes, prophylactic and therapeutic hemostatic transfusions
• Hemostatic Balance in Acute Liver Failure: epidemiology of bleeding and thrombosis, physiology, current strategies
• Hemostatic Balance in Severe Sepsis: epidemiology of bleeding and thrombosis, physiology, current strategies
• Hemostatic Balance of the Critically Ill Oncology Patient: epidemiology of bleeding and thrombosis, physiology, current strategies
• Hemostatic Balance in Critically Ill Cardiac Patient: epidemiology of bleeding and thrombosis, physiology, current strategies
• Controversies around Whole Blood and Cold Platelet Transfusions: physiology, current evidence, future directions.
