Perioperative Anemia and Coagulopathy Management in Pediatric Patients with Medical Complexity.

Perioperative anemia and coagulopathy are frequent yet modifiable conditions in pediatric patients with medical complexity, significantly influencing surgical morbidity and mortality. Iron deficiency anemia is the most common type of anemia, underscoring the importance of early detection, dietary modification, and timely oral or intravenous iron supplementation. Restrictive transfusion thresholds and selective use of erythropoiesis-stimulating agents are recommended to reduce transfusion-related complications. Management of other nutritional (folate, vitamin B12, copper, and zinc) and non-nutritional anemias (eg, sickle cell disease) requires individualized approaches. Patient Blood Management principles guide perioperative care. Antifibrinolytics are effective in reducing bleeding and transfusion needs.