The development of hemostasis in the human fetus and newborn infant

Bleyer, W. Archie; Hakami, Nasrollah; Shepard, Thomas H.

doi:10.1016/s0022-3476(71)80405-5

Cited by 177 publications

(54 citation statements)

References 52 publications

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“…These data confirm the results in prenatal diagnosis of hemophilia (which is usually performed at the 18th wk of pregnancy) and the development of hemostasis in the human fetus (28,29).…”

Section: Discussionsupporting

confidence: 87%

Hematological Values of 163 Normal Fetuses between 18 and 30 Weeks of Gestation

et al. 1986

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ABSTRACT. Utilizing an easy and safe ~rocedure for fetal MATERIALS AND METHODSblood sampling in utero we have studied 409 fetuses for prenatal diagnosis of rubella, toxoplasmosis, hemophilia, and hemoglobinopathies. Retrospectively we selected 163 fetuses confirmed as normal at birth and tested between 18 and 30 wk of gestation to establish normal hematological parameters and to follow the evolution of erythropoiesis, differential counts, hemoglobin synthesis, and hemostasis. Total white blood cell and platelet counts did not change during this period. Our knowledge of fetal hematology is limited due to the fact that most earlier studies were performed on aborted fetuses or under sampling conditions which may have altered hematological values. Moreover, only a few hematological values during gestation have been published (1). Having developed an easy and safe technique for fetal blood sampling, we selected retrospectively for this study 163 fetuses born healthy at full term delivery to establish reference fetal hematological values using standardized methods. To date no fetal loss or premature labor has been attributed to these fetal samplings.Sampling procedure. The fetal sampling method has been described in detail previously (2, 3). A real time ultrasound scanner (ATL MARK 111) was used to locate the umbilical cord insertion on the placenta and to determine the best route of access to it without fetal interposition. The transducer was then maintained immobile while, under aseptic conditions, local anesthesia was performed with 1 % xylocaine into the anterior abdominal wall at the chosen puncture site. No /3-mimetic drugs or other medication were used prior to the procedure. A 20-gauge spinal needle (10 or 13 cm long), filled with 0.129 M sodium citrate solution and fixed to a 2 ml disposable syringe containing 0.1 ml of this solution, was introduced into the plane of the ultrasound sector near the transducer. The needle tip emitted a clearly visible echo and its progress toward the insertion of the cord was followed on the scope. The vein of the cord was punctured about 1 cm from its insertion.Immediately after the first d r o~ of blood was obtained, the syringe was replaced by a new one containing no additive. The blood sample was immediately transferred into special tubes containing adequate anticoagulant for biological studies. The duration of the entire procedure was less than 10 min in 90% of the cases, and the automated evaluations of hematological parameters were completed within 30 min.Patients. We studied 409 pregnancies and 435 fetal blood samplings were camed out (26 repetitive samplings) with the approval of the ethics committee of the hospital, the medical expert panel, and the informed consent of the patients. The fetal samplings were conducted for the prenatal diagnosis of toxoplasmosis (285 cases), rubella (37 cases), or hemophilia (30 cases), for rapid fetal karyotyping (32 cases), or for diagnosis of other miscellaneous conditions (25 cases). Medical abortions of affected fetuses were perfor...

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“…These data confirm the results in prenatal diagnosis of hemophilia (which is usually performed at the 18th wk of pregnancy) and the development of hemostasis in the human fetus (28,29).…”

Section: Discussionsupporting

confidence: 87%

Hematological Values of 163 Normal Fetuses between 18 and 30 Weeks of Gestation

et al. 1986

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“…The most direct is the demonstration that the absorbed antiserum, which inactivates AHF procoagulant activity, forms a single line in immunodiffusion studies with AHF-rich concentrates of normal human plasma (16 (b) The immaturity of the fetal endothelial cells and/ or the artificial conditions of the culture might affect AHF antigen synthesis in a way that would prevent the development of AHF procoagulant activity. Full-term newborns have normal levels of plasma AHF procoagulant activity even though AHF does not cross the placenta (33,34). It can be assumed, therefore, that the full-term fetus can synthesize functional AHF.…”

Section: Discussionmentioning

confidence: 99%

Synthesis of Antihemophilic Factor Antigen by Cultured Human Endothelial Cells

Jaffe¹,

Hoyer²,

Nachman³

1973

J. Clin. Invest.

1,227

409

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“…Literature analysis as recently given by Bleyer and coworkers [4] is fraught with many difficulties. (1) Most publications deal with only a few cases and therefore are of questionable statistical value.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Blood Clotting Factor Levels in Premature Infants during the First 10 Days of Life: A Study of 96 Cases with Comparison Between Clinical Status and Blood Clotting Factor Levels

et al. 1973

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ExtractFibrinogen and factors V, II, and VII + X assays were performed by micromethod on days 1, 2, 3, and 10 of life in 96 premature infants ( <37 weeks gestational age). "Sick" premature infants, mainly with respiratory distress syndrome, were compared with premature infants considered to be thriving. In the thriving infants, the mean level of the studied clotting factors appears to be independent of gestational age. Fibrinogen and factor V levels are correlated in thriving as well as in sick infants; both are significantly decreased in the sick infant group. In both groups, factors //and VII + Xlevels were consistently low on the 1st day of life. They progressively increased but did not reach adult levels by the 10th day of life despite routine vitamin K x administration. Overall mortality as well as clinical hemorrhagic manifestations were closely related to blood clotting factor levels. Pathologic and biologic data indicate a relation between coagulation abnormalities in premature infants and the occurrence of disseminated . intravascular clotting. SpeculationIt can be postulated that low levels of blood clotting factors result from either diminished production (immaturity, toxicity, etc.) or increased utilization or consumption (i.e., disseminated intravascular coagulation (DIG)). Hypercoagulability and disseminated intravascular coagulation have been described in premature infants, especially in those with respiratory distress. By means of microtechnics, it is now possible to study the evolution of blood clotting factor levels in premature infants with and without respiratory distress in an attempt to better understand the relation of blood clottinglevels and the presence of DIC. Introductionlarly useful for analysis of the rapid changes in the

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The development of hemostasis in the human fetus and newborn infant

Cited by 177 publications

References 52 publications

Hematological Values of 163 Normal Fetuses between 18 and 30 Weeks of Gestation

Hematological Values of 163 Normal Fetuses between 18 and 30 Weeks of Gestation

Synthesis of Antihemophilic Factor Antigen by Cultured Human Endothelial Cells

Evolution of Blood Clotting Factor Levels in Premature Infants during the First 10 Days of Life: A Study of 96 Cases with Comparison Between Clinical Status and Blood Clotting Factor Levels

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