What are Advances in Patient Blood Management for optimizing Pediatric Surgical Care?

Recently published article reviews paediatric patient blood management (PBM) which has transitioned from a blood component-focused approach to a patient-centered multimodal strategy aimed at optimizing blood health through evidence-based interventions. While PBM is recognized as a new standard of care, its implementation in paediatric populations is hindered by the lack of robust evidence supporting its efficacy and safety. The management of bleeding and transfusion in neonates, infants, children, and adolescents poses unique challenges due to age-related factors.

Key Principles of Paediatric Patient Blood Management

Key principles of PBM include screening for and treating anaemia, minimizing blood loss, and managing coagulopathic bleeding to enhance patient outcomes. Emphasizing patient safety and good clinical practice, PBM is a comprehensive, evidence-based, multidisciplinary, and preventive approach focused on patient outcomes rather than treatments of choice. The World Health Organization has urged the global adoption of PBM as a standard of care. The review discusses strategies for optimizing blood health, effective preoperative anaemia management, usage of antifibrinolytic agents, cell salvage techniques, algorithm-based transfusion practices, and postoperative management. Approaches such as acute normovolaemic haemodilution and use of recombinant factors offer novel avenues for blood conservation in paediatric patients. Additionally, the role of viscoelastography in guiding transfusion decisions and the importance of avoiding iatrogenic anaemia due to routine phlebotomy are highlighted. Multimodal blood conservation strategies during the perioperative period focus on individualized care, restrictive transfusion thresholds, and goal-directed interventions based on patient-specific needs. The narrative review underscores the necessity for further research to establish the efficacy, safety, and cost-effectiveness of PBM interventions tailored to paediatric populations. Future studies should investigate non-transfusion modalities, coagulation management with fibrinogen and prothrombin complex concentrates, and methods for monitoring tissue oxygen delivery to enhance transfusion decisions in paediatric patients.

Conclusion

In conclusion, PBM in paediatric populations aims to optimize patient outcomes while minimizing risks associated with blood transfusion. Implementing PBM protocols tailored to children requires more high-quality evidence and guidelines to improve care and outcomes for these vulnerable patient groups.

Key Points

- The field of paediatric patient blood management (PBM) has evolved to focus on a patient-centered approach with evidence-based interventions to optimize blood health in children.

- Key principles of PBM in pediatrics include screening and treating anaemia, minimizing blood loss, managing coagulopathic bleeding, and emphasizing patient safety and good clinical practice. - Strategies discussed in the review for optimizing blood health in paediatric patients include effective preoperative anaemia management, use of antifibrinolytic agents, cell salvage techniques, algorithm-based transfusion practices, and postoperative management.

- Innovative approaches like acute normovolaemic haemodilution and recombinant factors are highlighted as novel avenues for blood conservation in paediatric patients.

- Multimodal blood conservation strategies during the perioperative period stress individualized care, restrictive transfusion thresholds, and goal-directed interventions based on patient-specific needs.

- The narrative review emphasizes the need for further research to establish the efficacy, safety, and cost-effectiveness of PBM interventions tailored to paediatric populations, including investigating non-transfusion modalities, coagulation management, and tissue oxygen delivery monitoring for transfusion decisions in children.

Reference –

S. Goobie & David Faraoni (2024). Perioperative Paediatric Patient Blood Management: A Narrative Review.. *British Journal Of Anaesthesia*. https://doi.org/10.1016/j.bja.2024.08.034.