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

Favaloro, Emmanuel J.; Lippi, Giuseppe

doi:10.21037/atm.2017.04.18

Cited by 28 publications

(18 citation statements)

References 14 publications

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“…The normal reference range of neonatal coagulation‐related indicators is significantly different from that of adults . The level of coagulation factors in neonates is only 50% of that in adults, and the level of these factors does not reach the adult level until an infant is 6 months old .…”

Section: Discussionmentioning

confidence: 98%

“…The normal reference range of neonatal coagulation-related indicators is significantly different from that of adults. 4,5,19,26 The level of coagulation factors in neonates is only 50% of that in adults, and the level of these factors does not reach the adult level until an infant is 6 months old. 19 In addition, thrombin and its precursors in newborns are also at low level, which eventually leads to an increase in APTT and PT and a decrease in Fib.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the consumption of coagulation factors increases at birth, and the liver function is not mature, except for the coagulation factor V and factor VIII. The coagulation factors are lower in concentration neonates than in adults . In addition, neonates have a different balance of haemostasis than adults or infants.…”

Section: Introductionmentioning

confidence: 95%

“…The coagulation factors are lower in concentration neonates than in adults. [1][2][3][4][5] In addition, neonates have a different balance of haemostasis than adults or infants. It is in balance, but this balance is more labile, so in situations of an ill neonate, the risk of bleeding is increased.…”

mentioning

confidence: 99%

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Establishing a reference range for thromboelastograph parameters in the neonatal period

Qin

Chen

et al. 2019

Int J Lab Hematology

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IntroductionAcquired coagulation disorders are a common cause of neonatal bleeding. The thromboelastograph (TEG) comprehensively assesses haemostatic processes in the body. Unfortunately, the reference range of TEG parameters in the neonatal period has not yet been evaluated, which limits the use of the TEG in neonates. In this study, we aimed to establish the reference range of TEG parameters for the neonatal period.MethodsThis study included 371 full‐term infants (≥37 weeks of gestation), and we divided these infants into three groups according to age as follows: 1, 2‐7 and 8‐28 days. We measured their peripheral blood using TEG, coagulation routine and platelet count tests. We analysed differences among the groups.ResultsThe reference ranges for TEG parameters are presented as medians and reference ranges (2.5th and 97.5th percentiles) as follows: R (clot reaction time, seconds) 4.80 (2.80‐7.17), Angle (fibrin production rate) 69.90 (44.91‐78.89), K (clot kinetics, min) 1.40 (0.80‐4.50), MA (maximum amplitude, mm) 63.50(44.34‐74.66) and LY30 (lysis at 30 minutes, %) 0.10 (0.10‐6.95). There were significant differences in Angle, K, MA and LY30 values between the different neonatal day age groups.ConclusionThis study preliminarily establishes a reference range for TEG parameters during the neonatal period. The age of a newborn had a large influence on TEG parameters. Additionally, we demonstrated a correlation between laboratory tests and TEG parameters for this age period. The reference values provided herein are meaningful for future studies.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

mentioning

confidence: 99%

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Establishing a reference range for thromboelastograph parameters in the neonatal period

Qin

Chen

et al. 2019

Int J Lab Hematology

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“…Interestingly, TG that was re-examined when the patient was 6 months old demonstrated marked improvement of parameters, correlating with his clinical status and with physiologic developmental hemostatic changes observed at infancy. 22,23 Newborns and young infants display physiologically reduced levels of vitamin K-dependent coagulation factors, including FIX, which may impair emicizumab's mode of action. 22,23 This may explain the fact that our youngest patient suffered from bleeding during surgical intervention under emicizumab prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors—a single‐center cohort

Barg

Avishai

Budnik

et al. 2019

Pediatric Blood & Cancer

127

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Background: Emicizumab is a bispecific antibody that bridges factor IXa and factor X to restore hemostasis in patients with hemophilia A (HA). Its efficacy and safety have been proven in multicenter trials. However, real world data regarding its use in very young children are currently lacking. Ancillary test results for monitoring emicizumab's hemostatic effect and their clinical correlations are scarce. Methods:Children with HA and inhibitors treated by emicizumab were prospectively followed at our center. Laboratory follow-up included rotational thromboelastometry (ROTEM) and thrombin generation (TG), prior to and during treatment.Results: Eleven children whose median age was 26 months were treated by emicizumab and followed for a median of 36 weeks. During follow-up, none experienced hemarthrosis or any other spontaneous bleeds. For 7/11 patients, emicizumab prophylaxis was sufficient to maintain hemostasis without additional supplemental therapy. Only 4/11 patients were occasionally treated with recombinant activated FVII for trauma. Two minor surgeries were safely performed without supplemental therapy while another procedure was complicated by major bleeding. TG parameters improved for all patients, correlating with their clinical status. Interestingly, the lowest TG values were obtained for patients experiencing bleeding episodes, while ROTEM parameters in all patients were close to the normal range. Conclusions:This study confirms the safety and efficacy of emicizumab in reducing bleeds in young children with HA with inhibitors, including infants. However, surgeries warrant caution as emicizumab prophylaxis may not be sufficient for some procedures. TG may more accurately reflect the hemostasis state than ROTEM in pediatric patients treated with emicizumab. K E Y W O R D Semicizumab, hemophilia A, inhibitors, ROTEM, thrombin generation

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Development and Internal Validation of Model Predicting Postoperative Blood Loss Risk Among Children with Pulmonary Atresia Undergoing Cardiopulmonary Bypass

Shen

Wang

2020

Pediatr Cardiol

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

Cited by 28 publications

References 14 publications

Establishing a reference range for thromboelastograph parameters in the neonatal period

Establishing a reference range for thromboelastograph parameters in the neonatal period

Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors—a single‐center cohort

Development and Internal Validation of Model Predicting Postoperative Blood Loss Risk Among Children with Pulmonary Atresia Undergoing Cardiopulmonary Bypass

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