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| Viscoelastic testing in pediatrics Meera Chitlur. |
Abstract
The pediatric hemostatic system is a dynamic and complex entity, characterized by "developmental hemostasis" where coagulation protein levels and activities evolve significantly from birth through adolescence. Traditional conventional coagulation tests (CCTs), such as prothrombin time (PT) and activated partial thromboplastin time (aPTT), possess critical limitations in this population: they fail to provide a global assessment of hemostasis, do not capture the functional contribution of platelets or fibrinolysis, require relatively large blood volumes, and often suffer from slow turnaround times. Viscoelastic testing (VET), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), addresses these needs by providing a rapid, real-time, and holistic assessment of the entire clotting process—from initiation to lysis—using significantly smaller blood volumes. Clinical evidence in children undergoing cardiac, trauma, and transplant surgeries demonstrates that VET-guided transfusion algorithms significantly reduce blood product requirements, shorten intensive care unit stays, and decrease overall hospital costs. Despite these advantages, the use of VET in pediatrics remains in the preliminary stages. To establish VET as a gold standard, there is an urgent need for age-specific reference ranges and standardized protocols that account for the unique developmental stages of the pediatric hemostatic system. This presentation will cover the current literature on the use of VET to study hemostasis in children and also look at the limitations and challenges.
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