Point-of-care testing of neonatal coagulation

Tan, Kenneth; Booth, D. Terrance; Newell, S J; Dear, P. R. F.; Hughes, Ciara; Richards, Michael

doi:10.1111/j.1365-2257.2006.00765.x

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…Its advantages include the need for small volumes of blood, reducing the risk of iatrogenic anaemia,2 and the timely availability of results, diminishing the interval between receipt of a result and therapeutic intervention 2…”

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confidence: 99%

Point of care estimation of haemoglobin in neonates

Hinds

Brown

Clark

2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objective: To evaluate whether measurement of haemoglobin concentration in neonates using point of care testing agrees with laboratory measurement. Design: 127 paired blood samples taken from babies on a neonatal intensive care unit for full blood count and blood gas analysis by point of care testing were reviewed according to current practice. A comparison was made between the laboratory and blood gas analyser haemoglobin measurements to assess limits of agreement and look for any systematic difference. Setting: Neonatal Unit, Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK Patients: Babies staying on the neonatal unit, who currently have contemporaneous blood samples taken for full blood count and blood gas analysis by point of care testing. Intervention: Results from blood samples were reviewed. Main outcome measure: Comparison between laboratory and point of care testing haemoglobin concentrations. Results: The mean laboratory haemoglobin concentration was 155 g/l (range 30-226 g/l); the mean point of care testing haemoglobin concentration was 157 g/l (range 30-228 g/l). The mean (SD) difference between paired samples was 2 (11) g/l; 95% CI 24.0 to 0.1 g/l; and limits of agreement 223 to 19 g/l. Conclusions: The blood gas analyser on the neonatal unit at Royal Hallamshire Hospital, Sheffield, gives a useful estimation of haemoglobin concentration compared with laboratory measurement, with smaller sample volume. Although this does not replace a full blood count, it is a useful adjunct to neonatal care monitoring. P oint of care testing can be defined as the testing of patient samples at the place where care is delivered. 1 Its advantages include the need for small volumes of blood, reducing the risk of iatrogenic anaemia, 2 and the timely availability of results, diminishing the interval between receipt of a result and therapeutic intervention. Babies requiring neonatal intensive care are susceptible to iatrogenic blood loss from frequent blood sampling, 3-7 which can hasten the onset or exacerbate the severity of anaemia. 5Occasionally babies receiving neonatal care may decompensate from occult blood loss-for example, large periventricular or intraventricular haemorrhage-necessitating prompt action on the basis of clinical assessment and timely results. The turnaround time of laboratory tests can be considerable, which may affect clinical decisions. 2Many neonatal units have blood gas analysers located on site, which are used exclusively for neonatal samples. Thus point of care testing is a routine part of neonatal practice. Many modern blood gas analysers can now estimate haemoglobin, glucose and electrolytes on every blood gas sample, without the need for increased sample volume. It has been suggested that the weekly full blood count (requiring 500 ml of blood) carried out for convalescing neonates, solely to identify anaemia, could be replaced by point of care testing (requiring 95 ml of blood).We therefore evaluated the performance of our blood gas analyser for this potential change in our service...

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confidence: 99%

Point of care estimation of haemoglobin in neonates

Hinds

Brown

Clark

2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…The American College of Chest Physicians, at the Eighth Consensus Conference on Antithrombotic and Thrombolytic Therapy, concluded that accuracy of point-of-care monitors for heparin therapy had thus far not been established [9]. A previously published study (with a different bedside device) in neonates reported underestimation at lower aPTT levels, and overestimation at higher levels [11]. The main finding of this study was that the bedside device substantially overestimated the aPTT in infants treated with heparin.…”

Section: Discussionmentioning

confidence: 55%

Evaluation of a bedside device to assess the activated partial thromboplastin time for heparin monitoring in infants

Vorst¹,

Wilde²,

Hogenbirk³

et al. 2013

Blood Coagulation &Amp; Fibrinolysis

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To determine the relationship between the activated partial thromboplastin time (aPTT) measured with a standard laboratory assay and the aPTT measured with a bedside device in infants on heparin therapy after cardiothoracic surgery. Twenty infants aged below 1 year who were on heparin therapy were included. Exclusion criteria were prematurity, dysmaturity and the use of anticoagulants other than heparin. Nineteen samples were obtained from four adults in intensive care who were on heparin. The aPTT values were analyzed with the Coaguchek Pro/DM bedside device (aPTTbed) and compared with the aPTT values obtained from the laboratory Electra 1800C coagulation analyzer (aPTTlab). Correlation analysis was performed by linear regression. The agreement was calculated using Bland-Altman analysis. The correlation coefficient of samples obtained from infants was lower (r = 0.48) compared with samples from adults (r = 0.85). A substantial positive bias (27 s) and scatter [95% confidence interval (CI) -11; +65 s) was found. The bias showed a genuine trend to increase at higher aPTT values (r = 0.90; P < 0.001). The bedside device overestimates the aPTT in infants treated with heparin. The disagreement between the bedside device and laboratory increases at higher aPTTs. Bedside devices should not be used to monitor heparin therapy in infants in intensive care.

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“…Screening for coagulopathy can be technically difficult, as samples heparin-contaminated samples and a relatively large volume of blood is required equivalent to 3% of circulatory volume in a 500 g infant. Further studies may become more practical in this era of point-of-care (POC) technology using smaller samples [23].…”

Section: Discussionmentioning

confidence: 99%

Decreased fibrinogen levels are associated with severe intraventricular hemorrhage in very low birth weight (VLBW) infants

White

Twomey

Donoghue

et al. 2011

Journal of Neonatal-Perinatal Medicine

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Reference ranges for coagulation screens in preterm infants were formulated in the 1980s. Preterm infants are at risk of hypocoagulable states due to hepatic immaturity, hypoxia, respiratory distress syndrome and sepsis. Coagulation profiles of very low birthweight (VLBW) infants were assessed and adverse outcomes recorded. A total of 32 VLBW infants had coagulation studies in the first week of life. Fibrinogen was significantly decreased on the third day of life in infants with severe intraventricular hemorrhage (IVH) compared with those with no or mild IVH. Further research on VLBW coagulation profiles may become easier with the development of point-of-care technology.

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Point-of-care testing of neonatal coagulation

Cited by 9 publications

References 10 publications

Point of care estimation of haemoglobin in neonates

Point of care estimation of haemoglobin in neonates

Evaluation of a bedside device to assess the activated partial thromboplastin time for heparin monitoring in infants

Decreased fibrinogen levels are associated with severe intraventricular hemorrhage in very low birth weight (VLBW) infants

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