What's New in Pediatric Patient Blood Management for Major Surgery?

Pediatric patient blood management (PBM) encompasses optimizing red cell mass and the physiologic reserve of anemia, as well as minimizing blood loss. Our goal, built around an illustrative case and the best practices of each tenet of PBM, is to give evidence-based pragmatic suggestions for multidisciplinary pediatric physicians in each phase of care: preoperative, intraoperative, postoperative. Many PBM reviews focus on the intraoperative management of the most severely ill patients, such as cardiac surgery. This review will focus on PBM in the general pediatric surgical population. New research was identified on the following topics: global prevalence of anemia, oral and IV iron supplementation, pre-operative transfusion risk scores, transfusion guidelines in pediatric critical care, antifibrinolytics, and viscoelastic testing. Post-operative PBM is an arena ripe for research given the paucity of evidence around the best management of anemia in children after surgery. This review discusses the current evidence for PBM in children, as well as many opportunities for research and improvement in this relatively new discipline.