Developmental haemostasis. Impact for clinical haemostasis laboratories.
Developmental haemostasis is a concept, now universally accepted, introduced by Andrew et al. in the late 1980's. However, coagulation analysers and reagents have changed significantly over the past 15 years. Coagulation testing is known to be sensitive to changes in individual reagents and analysers. We hypothesised that the reference ranges developed by Andrew et al. may not be appropriate for use in a modern coagulation laboratory. Our study was designed to determine whether a current day coagulation testing system (STA Compact analyser and Diagnostica Stago reagent system) was sensitive to age-related changes in coagulation assays. This is the first large scale study since Andrew et al. to determine the age associated numerical changes in coagulation proteins. Our results confirm the concepts of developmental haemostasis elucidated by Andrew et al. However, our results clearly demonstrate that the absolute values of reference ranges for coagulation assays in neonates and children vary with analyser and reagent systems. The results confirm the need for coagulation laboratories to develop age-related reference ranges specific to their own testing systems. Without this, accurate diagnosis and management of neonates and children with suspected bleeding or clotting disorders is not possible. Finally we present age related reference ranges for D-dimers, TFPI, and endogenous thrombin potential, previously not described.
Monagle
Paul
P
Department of Haematology, Royal Children's Hospital Melbourne, and University of Melbourne, Grattan Street, Parkville, Victoria 3051, Australia. paul.monagle@rch.org.au
Barnes
Chris
C
Ignjatovic
Vera
V
Furmedge
Janine
J
Newall
Fiona
F
Chan
Anthony
A
De Rosa
Lidia
L
Hamilton
Simone
S
Ragg
Philip
P
Robinson
Stephen
S
Auldist
Alex
A
Crock
Cathy
C
Roy
Neil
N
Rowlands
Shelley
S
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001780:Blood Coagulation Tests / Q000295:instrumentation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D005338:Fibrin Fibrinogen Degradation Products / Q000592:standards; D006487:Hemostasis; D006803:Human Development / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007755:Laboratories, Hospital; D008074:Lipoproteins / Q000592:standards; D012016:Reference Values; D013917:Thrombin / Q000592:standards
D005338:Fibrin Fibrinogen Degradation Products; D008074:Lipoproteins; C036309:fibrin fragment D; C051928:lipoprotein-associated coagulation inhibitor; D013917:Thrombin