# Blood Product Transfusion and Coagulopathy in Children with Traumatic Brain Injury: A Narrative Review

## TL;DR

This review examines how blood product transfusions affect children with traumatic brain injury and coagulopathy, highlighting gaps in pediatric-specific data and guidelines.

## Contribution

The paper provides a narrative review of pediatric-specific literature on blood transfusion and coagulopathy in TBI, emphasizing the need for more targeted research.

## Key findings

- Pediatric data on blood product transfusion in TBI is limited and lacks prospective studies.
- Transfusion in pediatric TBI is associated with worse outcomes, but mechanisms are poorly understood.
- Current guidelines for blood transfusion in acute brain injury are not sufficiently tailored to children.

## Abstract

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. Knowledge gaps persist due to the limited availability of pediatric-specific data regarding blood product transfusion in TBI. In particular, there is a lack of prospective studies defining appropriate specific laboratory thresholds and transfusion targets, as well as insufficient evidence to guide the weighing of potential benefits against transfusion-related risks in this population. Although blood product transfusion in pediatric TBI has been associated with worse clinical outcomes, the underlying mechanisms and contributing factors remain poorly understood. In this review, we aimed to describe the pediatric literature on component and whole blood product transfusion in children with TBI and the pathophysiological mechanisms underlying the development of coagulopathy in this population. In addition, we incorporated available pediatric guidelines and recommendations specific to the setting of acute brain injury.