title: Perioperative bleeding management in pediatric patients.
abstract: OBJECTIVE
  Managing the bleeding pediatric patient perioperatively can be extremely challenging. The primary goals include avoiding hypotension, maintaining adequate tissue perfusion and oxygenation, and maintaining hemostasis. Traditional bleeding management has consisted of transfusion of autologous blood products, however, there is strong evidence that transfusion-related side-effects are associated with increased morbidity and mortality in children. Especially concerning is the increased reported incidence of noninfectious adverse events such as transfusion-related acute lung injury, transfusion-related circulatory overload and transfusion-related immunomodulation. The current approach in perioperative bleeding management of the pediatric patient should focus on the diagnosis and treatment of anemia and coagulopathy with the transfusion of blood products only when clinically indicated and guided by goal-directed strategies.
  
  
  RESULTS
  Current guidelines recommend that a comprehensive multimodal patient blood management strategy is critical in optimizing patient care, avoiding unnecessary transfusion of blood and blood product and limiting transfusion-related side-effects.
  
  
  CONCLUSIONS
  This article will highlight current guidelines in perioperative bleeding management for our most vulnerable pediatric patients with emphasis on individualized targeted intervention using point-of-care testing and specific coagulation products.
authors: aDepartment of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA bDepartment of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
authors: Susan M
authors: SM
authors: Goobie
authors: Thorsten
authors: T
authors: Haas
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D000740:Anemia / Q000175:diagnosis / Q000628:therapy; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000401:mortality / Q000592:standards; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D002648:Child; D003428:Cross Infection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D020896:Hypovolemia / Q000209:etiology / Q000628:therapy; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D065227:Transfusion Reaction / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000517:prevention & control
chemical_list: D000933:Antifibrinolytic Agents