BLOOD LOSS AND FLUID REPLACEMENT IN PEDIATRIC PATIENTS

Abstract

While strategies for the management of hemorrhage, transfusion and blood loss replacement in adults are well established, there aren’t any concrete, evidence-based recommendations for pediatrics. Promoting hemodynamic stability, preserving organ perfusion, minimizing transfusion-related injury, avoiding over-transfusion, and avoiding the deadly triad of coagulopathy, acidosis, and hypothermia are among the objectives of bleeding therapy in pediatric patients. At the beginning of treatment, crystalloid or colloid solutions may be used until blood products are available. Preventing dilutional coagulopathy requires caution. Monitoring end-organ perfusion and maintaining a healthy blood pressure are essential. Red blood cell transfusion should be matched with “yellow” blood product transfusion in the form of a 1:1:1:1 volume ratio of PBRC: fresh frozen plasma (FFP): cryoprecipitate: platelets form, in order to prevent coagulopathy and preserve sufficient oxygen supply to tissues. Hemolytic transfusion reactions, transfusion-related acute lung injury (TRALI), transfusionassociated circulatory overload (TACO) and transfusion-related immunomodulation (TRIM) are only few of the hazards connected with blood transfusion. Rapid and appropriate access for blood product transfusions is essential. To calculate the maximum permitted blood loss, a weight-based estimated blood volume (EBV) is used. A tried-and-true strategy for managing intraoperative hemorrhage should be used, including blood preservation techniques, balanced transfusion ratios and adjunct medicines. Transfusion decisions may be influenced by point-of-care and laboratory tests, such as thromboelastography. Transfusion-related laboratory abnormalities should be watched for and treated as appropriate. Children’s platelet transfusion thresholds are unclear; however, maintaining a platelet count of 50,000/L while bleeding continues is seen as sufficient in adults. When EBV loss surpasses 50%, fresh frozen plasma (FFP) and platelet transfusions should be taken into consideration. Electrolyte levels, particularly those of calcium, magnesium and potassium, need to be monitored. As a result, controlling severe bleeding and transfusion in pediatric patients necessitates specialized approaches, such as meticulous preoperative planning, goal-directed therapy and monitoring of laboratory derangements. PBM program implementation can improve patients’ outcomes and lower transfusion-related hazards.