Figure 3. Potential mechanisms involved in the trauma-induced coagulopathy in children.

There is much adult literature detailing mechanisms and drivers of acute traumatic coagulopathy (ATC) and iatrogenic coagulopathy (IC). The classical physiologic drivers include hypothermia, acidosis, dilution secondary to intravenous administration of crystalloids and consumption of coagulation factors and might be similar between children and adults, although there is a limited description of these mechanisms in pediatric trauma. There is recent evidence for a distinct mechanism for early ATC in patients who have not been exposed to the traditional coagulopathy triggers and that may involve the activation of the anticoagulant protein C pathway, the Weibel-Palade body degradation and glycocalyx shedding. Whether these new mechanisms of ATC play a role in children is still unknown. TM: Thrombomodulin, TPA: tissue plasminogen activator, PAI-1: plasminogen activator inhibitor −1. Figure modified from [76] and [124].