Updates in perioperative hemostasis in the pediatric surgical patient.

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Maintaining hemostasis in pediatric patients undergoing major surgery presents unique challenges for the anesthesiologist. This review presents the most recent updates on pediatric perioperative bleeding and hemostasis management. Patient blood management (PBM) programs remain scarcely implemented, but recent evidence for restrictive transfusion thresholds and reduction in allogeneic blood products in the pediatric population is growing. Notable updates include support for pediatric PBM programs, restrictive transfusion thresholds, increased use of viscoelastic testing, safety and efficacy of whole blood, and management of coagulopathy in trauma. PBM programs and their key components have gained traction in the pediatric population in recent years: treating preoperative anemia, optimizing coagulation, and tolerating physiologic anemia through restrictive transfusion thresholds. Further evidence in the pediatric population is needed to guide the anesthesiologist.