Hematological problems in pediatric intensive care

Hematologic abnormalities are common in children admitted to pediatric intensive care units (PICUs). Some are primary and related to the underlying hematologic disease in the child such as severe anemia in a young child with sickle cell disease and an acute splenic sequestration crisis. Others are secondary to other underlying conditions such as disseminated intravascular coagulation secondary to sepsis. Perhaps the most common association is with surgery or following trauma. The approach to the diagnosis and management of hematologic disorders in children cared for in PICUs requires an appreciation of disorders, some very rare, where delays in diagnosis and initiation of effective treatment can be associated with significant morbidity/mortality (e.g. Thrombotic thrombocytopenic purpura, hemophagocytic lymphohistiocytosis) as well as more 'mundane' but equally important decisions such as transfusion triggers for replacement of packed red blood cells, fresh-frozen plasma, cryoprecipitate or platelets. In all situations, a best practice approach based on available published evidence and expert opinion is recommended. In large tertiary/quaternary care centers, a close working relationship between the pediatric intensivist staff and the clinical/laboratory hematology services is essential for optimizing the care of critically ill children with hematologic problems cared for in PICUs.