Patient Blood Management in Pediatric Patients: Current Strategies and Future Perspectives

Patient blood management (PBM) is an evidence-based, multidisciplinary approach aimed at optimizing the care of patients who might require transfusion. While PBM has been widely adopted in adult practice, its application in pediatric settings remains limited and inconsistent despite the unique physiological and clinical challenges of this population. This review highlights the current strategies and future directions of PBM in pediatric patients. Key elements of pediatric PBM include the preservation of red cell mass and the management of preoperative anemia, strategies to minimize iatrogenic and surgical blood loss, approaches to enhance patients’ physiological tolerance to anemia, and optimization of transfusion practices. Recent studies support the use of restrictive transfusion thresholds for critically ill children, neonates, and specific high-risk groups such as those with congenital heart disease, demonstrating no added benefit of liberal transfusion practices. Looking ahead, advances in precision medicine, artificial intelligence, and noninvasive monitoring technologies are expected to further individualize transfusion practices and strengthen PBM implementation in pediatric care. However, high-quality pediatric-specific research remains essential to establish standardized protocols and ensure safe, effective, and patient-centered blood management.