Developmental haemostasis

Paul Monagle; Chris Barnes; Vera Ignjatovic; Janine Furmedge; Fiona Newall; Anthony Chan; Lidia De Rosa; Simone Hamilton; Philip Ragg; Stephen Robinson; Alex Auldist; Cathy Crock; Neil Roy; Shelley Rowlands

doi:10.1160/TH05-01-0047

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 95(02): 362-372
DOI: 10.1160/TH05-01-0047

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Developmental haemostasis

Impact for clinical haemostasis laboratories

Paul Monagle

¹Department of Haematology

⁴Department of Pathology, University of Melbourne, Australia

,

Chris Barnes

¹Department of Haematology

,

Vera Ignjatovic

¹Department of Haematology

⁵Murdoch Children’s Research Institute, Melbourne, Australia

,

Janine Furmedge

¹Department of Haematology

,

Fiona Newall

¹Department of Haematology

,

Anthony Chan

⁶Department of Paediatrics, McMaster University, Hamilton, Canada

,

Lidia De Rosa

¹Department of Haematology

,

Simone Hamilton

¹Department of Haematology

,

Philip Ragg

²Department of Anaesthetics

,

Stephen Robinson

²Department of Anaesthetics

,

Alex Auldist

³Department of Surgery, Royal Children’s Hospital, Melbourne, Australia

,

Cathy Crock

¹Department of Haematology

,

Neil Roy

⁷Department of Neonatology

,

Shelley Rowlands

⁸Department of Obstetrics, Royal Women’s Hospital, Melbourne, Australia

› Author Affiliations

Abstract

Summary

Developmental haemostasis is a concept, now universally accepted, introduced by Andrew et al. in the late 1980’s. However, coagulation analysers and reagents have changed significantly over the past 15 years. Coagulation testing is known to be sensitive to changes in individual reagents and analysers. We hypothesised that the reference ranges developed by Andrew et al. may not be appropriate for use in a modern coagulation laboratory. Our study was designed to determine whethera current day coagulation testing system (STA Compact analyser and Diagnostica Stago reagent system) was sensitive to agerelated changes in coagulation assays. This is the first large scale study since Andrew et al. to determine the age associated numerical changes in coagulation proteins. Our results confirm the concepts of developmental haemostasis elucidated by Andrew et al. However, our results clearly demonstrate that the absolute values of reference ranges for coagulation assays in neonates and children vary with analyser and reagent systems. The results confirm the need for coagulation laboratories to develop age-related reference ranges specific to their own testing systems. Without this, accurate diagnosis and management of neonates and children with suspected bleeding or clotting disorders is not possible. Finally we present age related reference ranges for D-dimers, TFPI, and endogenous thrombin potential, previously not described.

Keywords

Reference ranges - developmental haemostasis - paediatric

Full Text

References

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