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Fifteen-minute consultation: a guide to paediatric major haemorrhage
  1. Spyridon Karageorgos1,2,
  2. Dennis Ren2,3,
  3. Melanie Ranaweera2,
  4. Sean Casey2,4,
  5. Tom Solan2,5,
  6. Owen Hibberd2,6,
  7. Dani Hall2,7
  1. 1 Aghia Sophia Children's Hospital, Athens, Greece
  2. 2 Blizard Institute, Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
  3. 3 Division of Emergency Medicine, Children's National Hospital, Washington, Columbia, USA
  4. 4 Department of Paediatrics, Children's Health Ireland, Dublin, Ireland
  5. 5 Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
  6. 6 Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK
  7. 7 Department of Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
  1. Correspondence to Dr Dani Hall, Blizard Institute, Queen Mary University of London Faculty of Medicine and Dentistry, London, UK; danielle.hall{at}


Major trauma is a principal cause of morbidity and mortality in children. Severe haemorrhage is the second-leading cause of death in paediatric trauma, preceded by traumatic brain injury. Major haemorrhage protocols (MHPs), also known as ‘code red’ and ‘massive transfusion protocols’, are used to make large volumes of blood products rapidly available. Most recommendations for paediatric MHPs are extrapolated from adult data because of a lack of large, high-quality, prospective paediatric studies. However, applying adult data in a paediatric context requires caution due to differences in injury mechanisms and physiological responses between adults and children. Since major haemorrhage is a high-acuity low-occurrence event, MHP requires effective training, collaboration and communication among a large multidisciplinary team.

In this 15-minute consultation, we provide an evidence-based synthesis of the management principles of paediatric major haemorrhage.

  • Paediatric Emergency Medicine
  • Paediatrics

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  • X @spiroskarageo, @DennisRenMD, @danihalltweets

  • SK and DR contributed equally.

  • Contributors Study design: DR, SK and DH. Images/tables—DR and SK. Infographics—OH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.