title: Severe pediatric blunt trauma--successful ROTEM-guided hemostatic therapy with fibrinogen concentrate and no administration of fresh frozen plasma or platelets.
abstract: Use of allogeneic blood products to treat pediatric trauma may be challenged, particularly in relation to safety. We report successful treatment of a child with severe abdominal and pelvic injuries with preemptive fibrinogen supplementation followed by rotational thromboelastometry (ROTEM)-guided, goal-directed hemostatic therapy. Fibrinogen concentrate was administered (total dose: 2 g), while transfusion of fresh frozen plasma and platelet concentrate was avoided. Activated partial thromboplastin time was prolonged and Quick values were low but ROTEM clotting time values remained normal, therefore, no thrombin-generating drugs were considered necessary. This case shows the potential for hemostatic treatment with coagulation factor concentrates to be applied to pediatric trauma.
authors.affiliation: Department of Anaesthesiology, Perioperative Medicine and General Intensive Care, SALK University Hospital, Salzburg, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ziegler
authors.forename: Christa
authors.initials: C
authors.lastname: Schimke
authors.forename: Peter
authors.initials: P
authors.lastname: Marchet
authors.forename: Birgit
authors.initials: B
authors.lastname: Stögermüller
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
mesh_terms: D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D002648:Child; D005340:Fibrinogen / Q000008:administration & dosage*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000097:blood / Q000188:drug therapy*; D013916:Thrombelastography / Q000379:methods*
chemical_list: D001779:Blood Coagulation Factors; D006490:Hemostatics; D005340:Fibrinogen