title: Transfusion therapy in paediatric trauma patients: a review of the literature.
abstract: Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT).Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. Determining the triggers for MTP activation in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma patients.MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.Considering the high prevalence of early coagulopathy in paediatric trauma patients, immediate identification and implementation of VHA-directed treatment of traumatic coagulopathy could ensure faster haemostasis and thereby, potentially, reduce bleeding as well as the total transfusion requirements and further improve outcome in paediatric trauma patients. Prospective randomized trials investigating this therapeutic approach in paediatric trauma patients are highly warranted.
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. kristinnystrup@gmail.com.|Department of Paediatrics, Næstved Hospital, Ringstedgade 61, Næstved, DK-4700, Denmark. kristinnystrup@gmail.com.
authors.forename: Kristin Brønnum
authors.initials: KB
authors.lastname: Nystrup
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. jakob.stensballe@regionh.dk.|Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. jakob.stensballe@regionh.dk.
authors.forename: Jakob
authors.initials: J
authors.lastname: Stensballe
authors.affiliation: Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. morten.boettger@regionh.dk.
authors.forename: Morten
authors.initials: M
authors.lastname: Bøttger
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. per.johansson@regionh.dk.|Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, Houston, TX, USA. per.johansson@regionh.dk.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. sisse.ostrowski@gmail.com.
authors.forename: Sisse R
authors.initials: SR
authors.lastname: Ostrowski
mesh_terms: D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion; D002648:Child; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*