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Semin Thromb Hemost 2007; 33(8): 816-820
DOI: 10.1055/s-2007-1000373
© Thieme Medical Publishers

Coagulation Testing in Pediatric Patients: The Young Are Not Just Miniature Adults

Giuseppe Lippi1 , Massimo Franchini2 , Martina Montagnana3 , Gian Cesare Guidi1
  • 1Professor, Sezione di Chimica Clinica, Dipartimento di Scienze Biomediche e Morfologiche, Università di Verona, Verona, Italy
  • 2Servizio di Immunoematologia e Trasfusione - Centro Emofilia, Azienda Ospedaliera di Verona, Verona, Italy
  • 3Sezione di Chimica Clinica, Dipartimento di Scienze Biomediche e Morfologiche, Università di Verona, Verona, Italy
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Publikationsdatum:
04. Januar 2008 (online)

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ABSTRACT

During the past few decades, great progress has been made toward a better understanding of the development of the hemostatic system. It is now clear that the physiology of hemostasis in pediatric patients differs widely from that in adults, supporting the hypothesis that children might have natural protective mechanisms that justify such variations. However, the correct interpretation of hemostasis test results in young patients, along with a deep understanding of the normal postnatal development in the human coagulation system, are essential prerequisites to the proper investigation of thrombotic and hemorrhagic problems in pediatric patients. Because the hemostatic system is not fully mature by 3 to 6 months of age, it is important to recognize that interpretation of laboratory data in pediatric patients must be accompanied by appropriate age-dependent reference ranges, which should also be specific for the testing system used, to prevent misclassification of children as having defects of factors and inhibitors of the coagulation system.

KEYWORDS

Coagulation testing - hemostasis - hemorrhages - pediatrics - thrombosis

REFERENCES

  • 1 Bleyer W A, Hakami N, Shepard T H. The development of hemostasis in the human fetus and newborn infant.  J Pediatr. 1971;  79 838-853
    PubMedSuche in Google Scholar
  • 2 Kenet G, Nowak-Gottl U. Bleeding and thrombosis issues in pediatric patients: current approach to diagnosis and treatment.  Acta Haematol. 2006;  115 137-140
    CrossrefPubMedSuche in Google Scholar
  • 3 Hassan H J, Leonardi A, Chelucci C et al.. Blood coagulation factors in human embryonic development: preferential expression of the FVII/tissue factor pathway.  Blood. 1990;  76 1158-1164
    PubMedSuche in Google Scholar
  • 4 Karpatkin M, Blei F, Hurlet A, Greco A, Tang Z. Prothrombin expression in the adult and fetal rabbit liver.  Pediatr Res. 1991;  30 266-269
    PubMedSuche in Google Scholar
  • 5 Saleh A A, Alshameeri R S, O'Brien J M et al.. Maternal and neonatal primary hemostasis.  Thromb Res. 1994;  73 125-129
    CrossrefPubMedSuche in Google Scholar
  • 6 Manco-Johnson M, Nuss R. Hemostasis in the neonate.  Neo Rev. 2000;  1 e191-e195
    PubMedSuche in Google Scholar
  • 7 Franchini M, Lippi G, Veneri D, Targher G, Zaffanello M, Guidi G C. Inherited platelet disorders.  Clin Chim Acta. 2008;  387 1-8
    CrossrefPubMedSuche in Google Scholar
  • 8 Franchini M, Lippi G. The role of von Willebrand factor in hemorrhagic and thrombotic disorders.  Crit Rev Clin Lab Sci. 2007;  44 115-149
    CrossrefPubMedSuche in Google Scholar
  • 9 Sutor A H. New aspects of vitamin K prophylaxis.  Semin Thromb Hemost. 2003;  29 373-376
    Thieme ConnectPubMedSuche in Google Scholar
  • 10 Hathaway W E. Insights on vitamin K.  Hematol Oncol Clin North Am. 1987;  1 367-379
    PubMedSuche in Google Scholar
  • 11 Cornelissen E A, Kollee L A, De Abreu R A et al.. Effects of oral and intramuscular vitamin K prophylaxis on vitamin K1, PIVKA-II, and clotting factors in breast fed infants.  Arch Dis Child. 1992;  67 1250-1254
    PubMedSuche in Google Scholar
  • 12 Karpatkin M. Coagulation problems in the newborn.  Semin Neonatol. 1999;  4 67-73
    PubMedSuche in Google Scholar
  • 13 Nowak-Gottl U, Kosch A, Schlegel N. Neonatal thromboembolism.  Semin Thromb Hemost. 2003;  29 227-234
    Thieme ConnectPubMedSuche in Google Scholar
  • 14 Heller C, Nowak-Gottl U. Maternal thrombophilia and neonatal thrombosis.  Best Pract Res Clin Haematol. 2003;  16 333-345
    CrossrefPubMedSuche in Google Scholar
  • 15 Nowak-Göttl U, Kosch A, Schlegel N, Salem M, Manco-Johnson M. Thromboembolism in children.  Curr Opin Hematol. 2002;  9 448-453
    CrossrefPubMedSuche in Google Scholar
  • 16 Nowak-Gottl U, Duering C, Kempf-Bielack B, Strater R. Thromboembolic diseases in neonates and children.  Pathophysiol Haemost Thromb. 2003;  33 269-274
    CrossrefPubMedSuche in Google Scholar
  • 17 Greenway A, Massicotte M P, Monagle P. Neonatal thrombosis and its treatment.  Blood Rev. 2004;  18 75-84
    CrossrefPubMedSuche in Google Scholar
  • 18 Marlar R A, Neumann A. Neonatal purpura fulminans due to homozygous protein C or protein S deficiencies.  Semin Thromb Hemost. 1990;  16 299-309
    Thieme ConnectPubMedSuche in Google Scholar
  • 19 Beardsley D S. Venous thromboemebolism in the neonatal period.  Semin Perinatol. 2007;  31 250-253
    CrossrefPubMedSuche in Google Scholar
  • 20 Andrew M. Developmental hemostasis relevance to thromboembolic complications in pediatric patients.  Thromb Haemost. 1995;  74 415-425
    PubMedSuche in Google Scholar
  • 21 Monagle P, Barnes C, Ignjatovic V et al.. Developmental haemostasis. Impact for clinical haemostasis laboratories.  Thromb Haemost. 2006;  95 362-372
    Thieme ConnectPubMedSuche in Google Scholar
  • 22 Pysher T J, Bach P R, Geaghan S M et al.. Teaching pediatric laboratory medicine to pathology residents.  Arch Pathol Lab Med. 2006;  130 1031-1038
    PubMedSuche in Google Scholar
  • 23 Andrew M, Paes B, Johnston M. Development of the haemostatic system in the neonate and young infant.  Am J Pediatr Hematol Oncol. 1990;  12 95-104
    CrossrefPubMedSuche in Google Scholar
  • 24 Andrew M, Paes B, Milner R et al.. Development of the human coagulation system in the full-term infant.  Blood. 1987;  70 165-172
    PubMedSuche in Google Scholar
  • 25 Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood.  Blood. 1992;  80 1998-2005
    PubMedSuche in Google Scholar
  • 26 Andrew M, Bhogal M, Karpatkin M. Factors XI and XII and prekallikrein in sick and healthy premature infants.  N Engl J Med. 1981;  305 1130-1133
    PubMedSuche in Google Scholar
  • 27 Andrew M, Paes B, Milner R et al.. Development of the human coagulation system in the healthy premature infant.  Blood. 1988;  72 1651-1657
    PubMedSuche in Google Scholar
  • 28 Karpatkin M, Mannucci P M, Bhogal M, Vigano S, Nardi M. Low protein C in the neonatal period.  Br J Haematol. 1986;  62 137-142
    PubMedSuche in Google Scholar
  • 29 Cohen L, McKinnell J, Puglisi V et al.. Prothrombin synthesis in the adult and fetal liver.  Thromb Haemost. 1997;  78 1468-1472
    PubMedSuche in Google Scholar
  • 30 Lippi G, Salvagno G L, Rugolotto S et al.. Routine coagulation tests in newborn and young infants.  J Thromb Thrombolysis. 2007;  24 153-155
    CrossrefPubMedSuche in Google Scholar
  • 31 Flanders M M, Crist R A, Roberts W L, Rodgers G M. Pediatric reference intervals for seven common coagulation assays.  Clin Chem. 2005;  51 1738-1742
    CrossrefPubMedSuche in Google Scholar
  • 32 Flanders M M, Phansalkar A R, Crist R A, Roberts W L, Rodgers G M. Pediatric reference intervals for uncommon bleeding and thrombotic disorders.  J Pediatr. 2006;  149 275-277
    PubMedSuche in Google Scholar
  • 33 Andrew M, Mitchell L, Vegh P. Thrombin regulation in children differs from adults in the absence and presence of heparin.  Thromb Haemost. 1994;  72 836-842
    PubMedSuche in Google Scholar
  • 34 Fritsch P, Cvirn G, Cimenti C et al.. Thrombin generation in factor VIII-depleted neonatal plasma: nearly normal because of physiologically low antithrombin and tissue factor pathway inhibitor.  J Thromb Haemost. 2006;  4 1071-1077
    CrossrefPubMedSuche in Google Scholar
  • 35 Albisetti M. The fibrinolytic system in children.  Semin Thromb Hemost. 2003;  29 339-348
    Thieme ConnectPubMedSuche in Google Scholar
  • 36 Parmar N, Albisetti M, Berry L R, Chan A K. The fibrinolytic system in newborns and children.  Clin Lab. 2006;  52 115-124
    PubMedSuche in Google Scholar
  • 37 Parmar N, Mitchell L G, Berry L R, Andrew M, Chan A K. The influence of age on in vitro plasmin generation in the presence of fibrin monomer.  Acta Haematol. 2006;  115 141-151
    CrossrefPubMedSuche in Google Scholar
  • 38 Sosothikul D, Seksarn P, Lusher J M. Pediatric reference values for molecular markers in hemostasis.  J Pediatr Hematol Oncol. 2007;  29 19-22
    CrossrefPubMedSuche in Google Scholar
  • 39 Rand M L, Kuhle S. Platelets and platelet function testing in children.  Prog Pediatr Cardiol. 2005;  21 63-69
    CrossrefPubMedSuche in Google Scholar
  • 40 Thornburg C, Pipe S. Neonatal thromboembolic emergencies.  Semin Fetal Neonatal Med. 2006;  11 198-206
    CrossrefPubMedSuche in Google Scholar

Prof. Giuseppe Lippi 

Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Ospedale Policlinico G.B. Rossi

Piazzale Scuro, 10, 37134 Verona, Italy

eMail: giuseppe.lippi@univr.it

eMail: ulippi@tin.it