Nour Al-Mozain: Massive Transfusion in Pediatrics
Nour Al-Mozain, Hemopathologist, Consultant at King Faisal Specialist Hospital and Research Center, shared a post on LinkedIn:
”Massive Transfusion in Pediatrics key takeaways from my talk at the 2nd International Hematology and Hemostasis Conference today.
Children are not small adults. Here is what the evidence actually says:
1․ Forget the ’10-unit rule’
Use weight-based thresholds. The number to remember: more than 10 mL/kg/h.
2․ The Lethal Triad starts at injury — not after treatment
Hypothermia, Acidosis and Coagulopathy is a primary phenomenon driven by ATC, protein C activation, and hyperfibrinolysis.
3. Adult SBP cutoffs will miss your sickest children
Use SIPA (HR divided by SBP, age-adjusted), Base Deficit less than −6, and the ABCD Score.
Remember, by the time SBP falls in a child, 30–40 percent of circulating volume is already gone.
4. 1:1:1 — balanced from the start, not as rescue; Component or Whole blood
5. TXA: the window is 3 hours
15 mg/kg IV over 10 minutes, followed by 2 mg/kg/h for 8 hours (for children under 12 years).
6. Calcium is Factor IV — and it is almost universally missed
97 percent of MT patients develop hypocalcaemia.
Check iCa²⁺ every 30 min or after each pack.
7. Empirical fibrinogen is not the answer
All the studies in adults.
Use ROTEM/FIBTEM-guided replacement if available.”
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