Hemostasis Management of the Pediatric Surgical Patient

1st Edition - October 19, 2023
Imprint: Academic Press
Editors: Nina A. Guzzetta, David Faraoni, Cassandra D. Josephson
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 0 4 5 9 - 9
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 0 4 6 0 - 5

Hemostasis Management of the Pediatric Surgical Patient provides knowledge on the emerging area of pediatric hemostasis and its management. It discusses aspects of periopera… Read more

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Hemostasis Management of the Pediatric Surgical Patient provides knowledge on the emerging area of pediatric hemostasis and its management. It discusses aspects of perioperative blood management in the pediatric population, including how to accurately estimate and monitor bleeding and determine optimal treatment regimens for bleeding in pediatric surgical patients. It also provides information on the implementation of intraoperative blood conservation strategies, goal-directed transfusion therapy, and postoperative estimation of bleeding and thrombotic risks. This book is a valuable resource to pediatric practitioners and researchers who need comprehensive information on pediatric hematology, from basic physiology to pre-, intra- and postoperative care of pediatric patients.

The coagulation system of children evolves with age as evidenced by marked physiological differences in the concentration of hemostatic proteins between children of different age groups and adults. Consequently, there are distinct differences in hemostatic management between adult and pediatric patients.

Cover image
Title page
Table of Contents
Copyright
Dedications
Contributors
Preface
Section I. Basics of hemostasis
Chapter 1. Mechanisms of hemostasis
Introduction to hemostasis
Primary hemostasis
Secondary hemostasis
Tertiary hemostasis
Summary
Chapter 2. Developmental hemostasis
Introduction
Primary hemostasis: developmental
Secondary hemostasis: developmental
Tertiary hemostasis: developmental
Summary
Chapter 3. Measuring and monitoring of hemostasis
Introduction
Measurement of hemostasis
Monitoring of hemostasis
Summary
Section II. Disorders of hemostasis in children
Chapter 4. Congenital bleeding and thrombotic disorders
Congenital bleeding disorders
Inherited thrombophilias
Summary for testing and prophylaxis in congenital thrombophilia
Summary
Chapter 5. Acquired disorders of hemostasis
Introduction
Acquired disorders of primary hemostasis
Acquired disorders of secondary hemostasis
Other acquired disorders of hemostasis
Summary
Section III. Blood bank management for pediatric patients
Chapter 6. Pediatric blood banking: blood components, derivatives, modifications, and pre-transfusion testing
Introduction
Blood collection and processing
Blood components and derivatives
Component preparation for the pediatric patient
Pretransfusion preparation and testing
Summary
Chapter 7. Consent and an approach to the management of acute and chronic transfusion reactions
Introduction
Consent to transfusion
Hemovigilance systems
Acute transfusion reactions
Delayed transfusion reactions
Transfusion-associated graft versus host disease
Transfusion-transmitted infections
Other long-term consequences
Summary
Section IV. Perioperative pediatric blood management
Chapter 8. Guidelines and administration of pediatric patient blood management programs
Patient blood management
Guidelines and efforts to implement pediatric blood management
Key ingredients of a pediatric patient blood management program
Summary
Chapter 9. Preoperative hemoglobin optimization in the pediatric patient
Introduction
Pediatric patient blood management
Pediatric perioperative optimal blood use
Treatment of preoperative anemia
Blood bank communication and product ordering
Specialized transfusion scenarios
Preoperative autologous blood donation
Summary
Chapter 10. Blood conservation strategies and alternatives to blood products
Autologous donation
Acute normovolemic hemodilution
Cell saver collection and reinfusion
Pharmacologic agents
Coagulant products
Red cell transfusion
Pediatric massive transfusion protocols
Whole blood
Blood substitutes/artificial oxygen carriers
Summary
Section V. Hemostatic management for specific surgical procedures
Chapter 11. Major spine and orthopedic surgery
Introduction
Preoperative coagulation testing
Blood saving strategies
Preoperative hemoglobin optimization
Antifibrinolytics
Perioperative bleeding management
Massive transfusion strategies
Summary
Chapter 12. Neurosurgical and craniofacial procedures
Preoperative assessment
Neurosurgical procedures associated with significant blood loss
Traumatic brain injury
Postoperative hemostasis and coagulopathy
Summary
Chapter 13. Cardiac surgery and cardiopulmonary bypass
Introduction
Coagulation challenges in pediatric cardiac patients
Cardiopulmonary bypass-associated coagulation alterations
Anticoagulation for cardiopulmonary bypass
Blood conservation
Management of bleeding after cardiopulmonary bypass
Special coagulation and hematologic concerns for cardiopulmonary bypass
Summary
Chapter 14. Extracorporeal membrane oxygenation and other extracorporeal devices
Introduction
Anticoagulation strategies
Monitoring of anticoagulation
Anticoagulation management
Ventricular assist devices
Summary
Chapter 15. Major abdominal surgery
Introduction
Perioperative changes of hemostasis in specific pathology
Current practice and recommendations for perioperative hemostasis management in specific surgical procedures
Summary
Chapter 16. Pediatric trauma
Introduction
Trauma-induced coagulopathy/trauma-induced blood failure
Hemostatic resuscitation
Massive transfusion
Life-threatening hemorrhage and massive transfusion protocols
Coagulation monitoring: conventional coagulation tests and viscoelastic tests
Hemostatic adjuncts in pediatric resuscitation
Monitoring and replacement of calcium during resuscitation
Summary
Chapter 17. Biomaterials and other adjuncts for pediatric hemostasis
Introduction
Physiology of wound healing
Topical hemostatic agents
Special considerations in pediatric cardiac surgery
Preclinical development: synthetic technologies
Summary
Section VI. Postoperative challenges in hemostasis
Chapter 18. Bleeding management in the ICU
Introduction
Definitions of postoperative blood loss
Postoperative bleeding and outcomes
Monitoring of coagulation and transfusion practices in the ICU
Contribution of adjunct interventions
Disseminated intravascular coagulation
Preparation for reoperation
Special postoperative bleeding considerations
Summary
Chapter 19. Postoperative thrombosis and prophylaxis
Introduction
Incidence of hospital-acquired venous thromboembolism
Risk factors for hospital-acquired venous thromboembolism
Hospital-acquired venous thromboembolism prophylaxis and treatment
Summary
Index

Nina A. Guzzetta

Biography: Dr. Guzzetta is Professor of Anesthesiology and Pediatrics at Emory University School of Medicine and Children’s Healthcare of Atlanta in Atlanta, Georgia, USA. She has been a practicing pediatric cardiac anesthesiologist since 1994. In addition to a busy clinical practice, she has performed extensive research focused on hemostasis in children, understanding the developmental changes in the hemostatic system of children and how these changes impact the clinical treatment of bleeding during major surgery. As a pediatric cardiac anesthesiologist, Dr. Guzzetta is particularly skilled in the hemostatic response to cardiopulmonary bypass (CPB) in neonates, infants and young children. Her research involves primarily translational or clinical investigations that focus on 1) understanding the maturational differences between the pediatric and adult hemostatic systems, 2) anticoagulation management of pediatric cardiac surgical patients undergoing CPB, 3) identification of factors associated with an increased risk of bleeding in children undergoing major surgery and 4) efforts to reduce bleeding and transfusion requirements including the use of novel pro-coagulant therapies. She has published numerous research articles, review articles and written book chapters on these important topics. Her expertise in the hemostatic system of children, her work with children presenting for major surgical procedures and her knowledge of pediatric blood conservation will help ensure the ultimate success of the proposed book.

Affiliations and expertise

Professor of Anesthesiology and Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA

David Faraoni

Dr. Faraoni is a Professor of Anesthesia at Baylor College of Medicine, and a practicing pediatric cardiac anesthesiologist at Texas Children’s Hospital in Houston, Texas. Originally from Belgium, Dr. Faraoni worked as a pediatric cardiac anesthesiologist and a clinical researcher at Queen Fabiola Children’s University Hospital and the Free University of Brussels, Boston Children’s Hospital and Harvard Medical School, and the Hospital for Sick Children and the University of Toronto.

Dr. Faraoni is involved in both clinical management and research initiatives examining blood conservation in pediatric patients undergoing major surgical procedures. His expertise in pediatric blood management poised him as the lead author in the development of 2019 NATA (Network for the Advance of Transfusion Alternatives) Guidelines for “Patient Blood Management for Neonates and Children Undergoing Cardiac Surgery”. He has authored numerous research articles, review articles, and book chapters on blood management for children undergoing major surgeries.

Affiliations and expertise

Professor of Anesthesia, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA

Cassandra D. Josephson

Cassandra Josephson, M.D. is Professor of Oncology and Pediatrics at Johns Hopkins University School of Medicine. She is currently the Director of the Cancer and Blood Disorders Institute, Clinical Division Director for Hematology/Oncology, Medical Director of Blood Banking/Transfusion Medicine and Apheresis, at the Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.

She hails from Florida where she attended the USF Health Morsani College of Medicine prior to training at the University of Colorado for her pediatric residency. Subsequently, she trained at Emory University College of Medicine for Pediatric Hematology/Oncology and Blood Banking/Transfusion Medicine training. She spent the following 20 years at Emory University prior to joining Johns Hopkins School of Medicine in 2022. Dr. Josephson’s research career focuses on pediatric transfusion medicine and, more specifically, transfusion therapy in neonates, sickle cell anemia, thalassemia, and massive transfusion in children with hemorrhage. She currently and previously garnered grants from National Institutes of Health, CDC, industry and private foundations where she is or has been the Principal Investigator. Dr. Josephson is actively involved in teaching medical students, residency, and fellowship trainees in pediatrics, pathology, anesthesia, and multiple surgical specialties. She has authored or co-authored high impact publications in peer-reviewed journals, in addition to numerous review articles and book chapters. She is one of the Co-Chairs for the REDS IV-Pediatrics Program evaluating Recipient Epidemiology and Donor Evaluation of Blood Products and Transfusion in the US and Brazil focused on Children. She also services as an Associate Editor for Transfusion, the journal of the Association for the Advancement of Blood & Biotherapies (AABB).

Affiliations and expertise

Professor of Oncology and Pediatrics, Johns Hopkins University, School of Medicine, and Director of Cancer and Blood Disorders Institute at the Johns Hopkins All Children’s Hospital, St. Petersburg Florida, Director of the Transfusion, Medicine, and Apheresis Service

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Hemostasis Management of the Pediatric Surgical Patient

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Nina A. Guzzetta

David Faraoni

Cassandra D. Josephson

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