L'hémostase en pédiatrie, ses particularités, les principales pathologies hémorragiques et leur gestion

In infants, and in particular in neonates, the complex mechanisms, preventing haemorrhage and thrombosis through platelets and proteins of coagulation and fibrinolysis, have important specificities compared to adults. Paediatric haemostasis is described as an evolving system with qualitative and quantitative changes and maturation throughout the foetal, neonatal and childhood period. Nevertheless, the haemostatic system remains balanced in full-term infant, without bleeding nor thrombosis but this balance is fragile. Since the clinical history of the child before the age of walking is poor, the biological exploration of haemostasis is required to assess a possible haemorrhagic risk before an invasive procedure. To ensure optimal detection of the increased bleeding risk, it is essential to take into account the personal and family history, the reference values for each age group, as well as any preanalytical interference, particularly related to difficulties of blood collection. This review will also address the main pathologies of haemostasis likely to be discovered during a preoperative paediatric evaluation.