Patient blood management (PBM) encompasses implementing multimodal evidence-based strategies to screen, diagnose, and properly treat anaemia and coagulopathies using goal-directed therapy while minimising bleeding. The aim of PBM is to improve clinical care and patient outcomes while managing patients with potential or ongoing critical anaemia, clinically significant bleeding, and coagulopathies. The focus of PBM is patient-centred rather than transfusion-centred. Multimodal PBM strategies are now recommended by international organisations, including the World Health Organization, as a new standard of care and a proven means to safely and effectively manage anaemia and blood loss while minimising unnecessary blood transfusion. Compared with adult PBM, paediatric PBM is currently not routinely accepted as a standard of care. This is partly because of the paucity of robust data on paediatric patient PBM. Managing paediatric bleeding and blood product transfusion presents unique challenges. Neonates, infants, children, and adolescents each have specific considerations based on age, weight, physiology, and pharmacology. This narrative review covers the latest updates for PBM in paediatric surgical populations including the benefits and principles of paediatric PBM, current expert consensus guidelines, and important universal multimodal therapeutic strategies emphasising clinical management of the anaemic, bleeding, or coagulopathic paediatric patient in the perioperative period. Practical paediatric rules for PBM in the perioperative period are highlighted, with review of specific PBM strategies including treatment of preoperative anaemia, restrictive transfusion thresholds, antifibrinolytic agents, cell salvage, standardised transfusion algorithms, and goal-directed therapy based on point-of-care and viscoelastic testing.

中文翻译：

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围手术期儿科患者血液管理：叙述性回顾


患者血液管理 （PBM） 包括实施多模式循证策略，以使用目标导向的疗法来筛查、诊断和正确治疗贫血和凝血病，同时最大限度地减少出血。PBM 的目的是改善临床护理和患者预后，同时管理潜在或持续的严重贫血、有临床意义的出血和凝血病的患者。PBM 的重点是以患者为中心，而不是以输血为中心。包括世界卫生组织在内的国际组织现在推荐多模式PBM策略作为一种新的护理标准和行之有效的方法，可以安全有效地管理贫血和失血，同时最大限度地减少不必要的输血。与成人 PBM 相比，儿科 PBM 目前并未被常规接受为标准护理。这部分是由于缺乏关于儿科患者 PBM 的可靠数据。管理儿科出血和血液制品输注是独特的挑战。新生儿、婴儿、儿童和青少年根据年龄、体重、生理学和药理学都有特定的考虑因素。本叙述性综述涵盖了儿科手术人群中 PBM 的最新更新，包括儿科 PBM 的益处和原则、当前的专家共识指南以及强调围手术期贫血、出血或凝血病儿科患者临床管理的重要通用多模式治疗策略。 重点介绍了围手术期 PBM 的实用儿科规则，并回顾了具体的 PBM 策略，包括术前贫血的治疗、限制性输血阈值、抗纤维蛋白溶解剂、细胞挽救、标准化输血算法以及基于床旁和粘弹性测试的目标导向治疗。