Indications of coagulation and/or fibrinolytic system activation in healthy and sick very-low-birth-weight neonates.
A combined hemostatic defect consisting of a reduction in certain procoagulants, anticoagulants (antithrombin III-ATIII-, protein C-PC-) and components of the fibrinolytic system (plasminogen-Plg-) was demonstrated in very-low-birth-weight infants (VLBW <1,500 g) with gestational age 26-32 weeks. Sixteen of them were healthy, 28 were suffering from RDS and 24 from septicemia. The hemostatic defect was more profound in the RDS group, nevertheless increased TAT (thrombin + ATIII complex) and/or PAP values (plasmin + a2-antiplasmin complex) was a more frequent finding in the septicemic group of infants (91.8 vs. 17.9%). Moderate-to-severe thrombocytopenia was detected in a higher percentage in the septicemic (70.8%) than in the RDS group (50%), and increased D-dimers were demonstrated in 34.8 and 28.6% of the infants, respectively. Elevated TAT or PAP values were not always associated with gross coagulation abnormalities, and advanced disseminated intravascular coagulation (DIC) was only documented in 16.7% of the septicemic and 7.1% of the RDS infants. None of the VLBW neonates presented with clinical evidence of thrombosis, although hemorrhagic manifestations were apparent in 34.8 and 14.3% of the neonates with septicemia or RDS, respectively, mainly due to DIC or severe thrombocytopenia. In conclusion, increased TAT and/or PAP values are good indicators of the in vivo activation of the hemostatic system, but still their impact on sick neonates morbidity and mortality remains unknown.
Aronis
S
S
Haemophilia and Haemostasis Unit, 'Aghia Sophia' Children's Hospital, Athens, Greece.
Platokouki
H
H
Photopoulos
S
S
Adamtziki
E
E
Xanthou
M
M
D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000150:complications; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005341:Fibrinolysin / Q000032:analysis; D005342:Fibrinolysis / Q000502:physiology*; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D007230:Infant, Low Birth Weight / Q000097:blood*; D007231:Infant, Newborn; D010447:Peptide Hydrolases / Q000032:analysis; D012016:Reference Values; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood*; D018805:Sepsis / Q000097:blood*; D013921:Thrombocytopenia / Q000150:complications; D000511:alpha-Macroglobulins / Q000032:analysis
D000511:alpha-Macroglobulins; C046193:antithrombin III-protease complex; C024668:plasmin-alpha(2)-macroglobulin complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D005341:Fibrinolysin