Abstract

Hemostatic testing in critically ill infants and children is essential yet challenging due to the immaturity and dynamic nature of the pediatric hemostatic system. Unlike adults, children, especially neonates, exhibit unique developmental differences in platelet function and coagulation factors, posing challenges for standard reference ranges and inadequate testing protocols, which mislead pediatric patients. Critical illnesses such as sepsis, trauma, liver dysfunction, and hematological or autoimmune disorders often exacerbate these vulnerabilities, increasing the risks of both bleeding and thrombotic complications. A broad spectrum of hemostatic disorders is encountered in this population, including quantitative and qualitative platelet abnormalities as well as inherited and acquired coagulation defects. Diagnostic evaluation relies on a combination of fundamental laboratory tests (platelet count, PT, aPTT, fibrinogen, BT, CT) and advanced assays (such as thromboelastography) to provide a comprehensive assessment. However, the accuracy and reliability of these tests are often compromised by errors, particularly concerning specimen handling and age-appropriate interpretation. Ultimately, healthcare professionals should have a thorough understanding of developmental hemostasis, meticulous adherence to testing protocols, and careful clinical interpretation are crucial for optimizing pediatric outcomes. Ongoing research into pediatric-specific norms and newer global assays will further enhance targeted and effective management strategies.

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