Acquired Disorders of Coagulation in Neonates and Children

Acquired disorders of coagulation, including both primary and secondary hemostasis, commonly occur in the critically ill neonate or child. In both the neonatal intensive care unit (NICU) and the pediatric intensive care unit (PICU), clinicians are confronted with acutely bleeding patients due to a myriad of causes including sepsis, trauma, liver failure, and renal failure. Sepsis is associated with multiple hematologic manifestations of varying severity including subclinical coagulopathy, disseminated intravascular coagulation (DIC), anemia, thrombocytopenia, and thrombosis. In this chapter, we will discuss the acquired coagulopathies associated with sepsis, thrombocytopenia-associated multiple organ failure (TAMOF), DIC, thrombotic thrombocytopenic purpura (TTP), and hemolytic-uremic syndrome (HUS) and how they lead to pediatric sequential multi-organ failure (pSMOF). In addition, we will discuss platelet dysfunction associated with renal failure as well as the acquired coagulation abnormalities that occur in the setting of liver failure and massive blood transfusion therapy for life-threatening bleeding.