50 Years of Pediatric Hemostasis: Knowledge, Diagnosis, and Treatment

Abstract

Studies from the past 50 years have contributed to the expanding knowledge regarding developmental hemostasis. This is a dynamic process that begins in the fetal phase and is characterized by physiological variations in platelet counts and function, and concentrations of most coagulation factors and the native coagulation inhibitors in early life, as compared with adulthood. The developmental hemostasis studies since the 1980 to 1990s established the laboratory reference values for coagulation factors. It was only a decade or two later, that thromboelastography (TEG) or (rotational thromboelastometry [ROTEM]) as well as thrombin generation studies, provided special pediatric reference values along with the ability to evaluate clot formation and lysis. In addition, global whole blood-based clotting assays provided point of care guidance for proper transfusion support to children hospitalized in intensive care units or undergoing surgery. Although uncommon, thrombosis in children and neonates is gaining increasing recognition, typically as a secondary complication in sick children. Bleeding in children, and particularly intracerebral hemorrhage in newborns, still represent a therapeutic challenge. Notably, our review will outline the advancements in understanding developmental hemostasis and its manifestations, with respect to the pathophysiology of thrombosis and bleeding complications in young children. The changes of transfusion policy and approach to thrombophilia testing during the last decade will be mentioned. Subsequently, a brief summary of the data on anticoagulant treatments in pediatric patients will be presented. Finally, we will point out the 10 most cited articles in the field of pediatric and neonatal hemostasis.

Age-related changes in thromboelastography profiles in injured children

“…These same factors that differentiate children from adults also distinguish children as they age from infancy to adolescence 1,4,16,20,21 . In the 18 years that encompass childhood, there is ongoing change and maturation of the hemostatic system, inflammatory and immune systems, especially in the first few months of life 4–6,22–27 . Multiple studies have shown young children have decreased levels of proteins involved in coagulation, fibrinolysis, and natural inhibitors of coagulation without increases in bleeding or thrombosis 6,8,24,28 .…”

“…1,4,16,20,21 In the 18 years that encompass childhood, there is ongoing change and maturation of the hemostatic system, inflammatory and immune systems, especially in the first few months of life. [4][5][6][22][23][24][25][26][27] Multiple studies have shown young children have decreased levels of proteins involved in coagulation, fibrinolysis, and natural inhibitors of coagulation without increases in bleeding or thrombosis. 6,8,24,28 However, injured children are often managed uniformly despite these developmental and physiologic differences.…”

2024 Eberhard F. Mammen Award Announcements: Part I—Most Popular Articles

“…Consequently, the most popular papers from each category are identified separately. Tables 3 and 4 respectively list the top 25 downloaded articles from STH in 2023 (from 2022 and 2023 inclusive), as eligible for either the “free access” ( Table 3 ) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 or “general category” ( Table 4 ) 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 awards.…”

“…The publisher of STH, Thieme, had in the past provided most material related to COVID-19 as free to download, and so COVID19-related material is less likely to be itemized in the “general category” list of most popular. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 The 25 most popular non-free to download papers are listed in Table 4 . The first two papers listed are the official winners of the 2024 Most Popular in the general category.…”

Celebrating 50 Years of Seminars in Thrombosis and Hemostasis—Part II

“…[7][8][9] Next in this issue is a review from Levy-Mendelovich and colleagues, discussing 50 years of pediatric hemostasis research. 10 These studies have contributed to the expanding knowledge of developmental hemostasis, a dynamic process that begins in the fetal phase and is characterized by physiological variations in platelet counts and function, as well as the concentrations of most coagulation factors and the native coagulation inhibitors in early life, as compared with adulthood. Developmental hemostasis studies since the 1980s to the 1990s established the laboratory reference values for coagulation factors.…”