Abstract
The majority of children undergoing pediatric cardiac surgery with cardiopulmonary
bypass require transfusion of blood products. The management of hemostasis in the
pediatric population is challenging, partly due to pronounced alterations in several
hemostatic parameters following cardiopulmonary bypass. Despite these marked changes
being seen quite often, they are not necessarily an indication for hemostatic interventions.
This review summarizes and discusses the available monitoring tests of hemostatic
impairment during and following pediatric cardiac surgery. It covers standard laboratory
tests, viscoelastic test, evaluation of platelet function, fibrinolysis, and the management
of anticoagulation including its reversal. Interpretation of hemostatic measurements
is done with due respect to the concept of developmental hemostasis, but also cyanotic
heart disease, which are considered by some to be associated with an increased risk
of bleeding.
Keywords
pediatric - cardiac surgery - cardiopulmonary bypass - point-of-care tests - developmental
hemostasis
