Individualized Bleeding Risk Assessment through Thromboelastography: A Case Report of May–Hegglin Anomaly in Preterm Twin Neonates

Amodeo, Ilaria; Raffaeli, Genny; Vianello, Federica; Cavallaro, Giacomo; Cortesi, Valeria; Manzoni, Francesca; Amelio, Giacomo Simeone; Gulden, Silvia; Mosca, Fabio; Ghirardello, Stefano

doi:10.3390/children8100878

Cited by 2 publications

(1 citation statement)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Viscoelastic coagulation tests are successfully used in adult critical care settings to guide transfusion practice, improving outcomes (121,131,132). In NICU, TEG and ROTEM are attractive owing to the peculiarity of the hemostatic system of the newborn, especially preterm, to assess the coagulation status and potential to drive FFP or platelets administration (19,22,92,124,(133)(134)(135)(136)(137)(138)(139)(140)(141)(142)(143)(144).…”

Section: Thromboelastography and Rotational Thromboelastometrymentioning

confidence: 99%

Hemostasis in neonatal ECMO

et al. 2022

Self Cite

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO) is a life-saving support for cardio-respiratory function. Over the last 50 years, the extracorporeal field has faced huge technological progress. However, despite the improvements in technique and materials, coagulation problems are still the main contributor to morbidity and mortality of ECMO patients. Indeed, the incidence and survival rates of the main hemorrhagic and thrombotic complications in neonatal respiratory ECMO are relevant. The main culprit is related to the intrinsic nature of ECMO: the contact phase activation. The exposure of the human blood to the non-endothelial surface triggers a systemic inflammatory response syndrome, which chronically activates the thrombin generation and ultimately leads to coagulative derangements. Pre-existing illness-related hemostatic dysfunction and the peculiarity of the neonatal clotting balance further complicate the picture. Systemic anticoagulation is the management's mainstay, aiming to prevent thrombosis within the circuit and bleeding complications in the patient. Although other agents (i.e., direct thrombin inhibitors) have been recently introduced, unfractionated heparin (UFH) is the standard of care worldwide. Currently, there are multiple tests exploring ECMO-induced coagulopathy. A combination of the parameters mentioned above and the evaluation of the patient's underlying clinical context should be used to provide a goal-directed antithrombotic strategy. However, the ideal algorithm for monitoring anticoagulation is currently unknown, resulting in a large inter-institutional diagnostic variability. In this review, we face the features of the available monitoring tests and approaches, mainly focusing on the role of point-of-care (POC) viscoelastic assays in neonatal ECMO. Current gaps in knowledge and areas that warrant further study will also be addressed.

show abstract

Section: Thromboelastography and Rotational Thromboelastometrymentioning

confidence: 99%

Hemostasis in neonatal ECMO

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

Case of Refractory Thrombocytopenia in Pregnancy Associated with May-Heglin Anomaly after Repeated Platelet Transfusions

Marzooq,

Husain,

Naseeb

2024

OJOG

View full text Add to dashboard Cite

May-Heglin Anomaly is an autosomal dominant disorder characterized by macrothrombocytopenia with a platelet function that is usually preserved. Platelets play an essential role in hemostasis. During pregnancy, a woman is susceptible to complications, including postpartum hemorrhage. Monitoring patients' hemostatic functions and observing the patient's clinical picture to maintain patient safety is paramount, while avoiding unnecessary therapeutic measures. This case report presents a rare instance of May-Heglin Anomaly (MHA) in a 35-year-old pregnant patient, with refractory thrombocytopenia despite receiving multiple platelet transfusions. Initially referred to as gravida 5 para 4 with severe thrombocytopenia at 28 weeks gestation, throughout her pregnancy, she was closely monitored and received over 40 units of platelets, which failed to increase her platelet count significantly. She delivered a healthy baby via vaginal delivery at 38 weeks, with her platelet count still critically low. This report highlights the challenges of managing MHA in pregnancy, the inefficacy of standard thrombocytopenia treatments such as platelet transfusion in MHA patients, and the importance of tailored management strategies to ensure maternal and fetal safety.

show abstract

Individualized Bleeding Risk Assessment through Thromboelastography: A Case Report of May–Hegglin Anomaly in Preterm Twin Neonates

Cited by 2 publications

References 33 publications

Hemostasis in neonatal ECMO

Hemostasis in neonatal ECMO

Case of Refractory Thrombocytopenia in Pregnancy Associated with May-Heglin Anomaly after Repeated Platelet Transfusions

Contact Info

Product

Resources

About