Developmental hemostasis: recommendations for laboratories reporting pediatric samples

Assembly and evaluation of an inventory of guidelines that are available to support clinical hematology laboratory practice

“…A total of 68 guidelines (one with an addendum) pertaining to clinical hematology laboratory practice were identified that had been posted or published in the public domain (Table ) , after adjudication of the documents found through searches of the published literature and websites. The organizations that had generated these guidelines included American Association of Clinical Chemistry (AACC) , British Committee for Standards in Haematology (BCSH) , College of American Pathologists (CAP) , Clinical and Laboratory Standards Institute (CLSI), European Molecular Genetics Quality Network (EMQM), European Society for Clinical Cell Analysis (ESCCA) , International Council for Standardization in Haematology (ICSH) , Institute for Quality Management in Healthcare (IQMH; formerly Quality Management Program – Laboratory Systems [QMP‐LS]) , ISTH , International Clinical Cytometry Society (ICCS) , International Society for Laboratory Hematology (ISLH) [50], North America Specialized Coagulation Laborato...…”

Translational aspects of developmental hemostasis: infants and children are not miniature adults and even adults may be different

“…Developmental hemostasis as regards to secondary hemostasis, meaning the 'blood clotting' aspects that involve the many coagulation factors, the oftencalled coagulation 'cascade', and the eventual conversion of fibrinogen to fibrin, was spearheaded by Andrew et al (1,2), and more recently confirmed and formalized by Monagle, Ignjatovic and colleagues (3,4). For example, (I) the concentration of vitamin K dependent coagulation factors, thrombin generation and clot lysis are all reduced in neonates compared with older children; (II) for the natural anticoagulants, the level of antithrombin is reduced in neonates, but reaches that of adults after around six months, whereas, in contrast, protein S and protein C is markedly reduced in neonates and both increase throughout childhood, although levels do not reach those of adults until adolescence (Table 1).…”

A Diagnostic Approach to a Child with Thrombosis

“…Deficiencies of the three natural anticoagulants are inherited in an autosomal dominant manner. All diagnostic laboratories processing pediatric samples for natural anticoagulants should use and interpret results according to age-, analyzer-and reagent-specific reference ranges [17]. It should be emphasized that a single laboratory test result below the 95% confidence limit for age is not enough to define an inherited state.…”