title: Repeated coagulation testing in children. Does it improve the diagnostic value?
abstract: BACKGROUND
  Mild bleeding disorders (BD) such as von Willebrand disease (VWD) type I are often difficult to diagnose because of inconclusive laboratory results. Our study examines the diagnostic value of repeated testing.
  
  
  METHODS
  Prospective study on 200 children. Extensive laboratory testing was done twice and a standardized history was taken.
  
  
  RESULTS
  165 patients completed the study (median age 5.6 years). Main reason for referral was aPTT prolongation (n = 109). The initial diagnosis was upheld in 74/165 (44.8%) children. Of 18 patients rated normal, 8 had to be reclassified as possible VWD later. Ten patients were diagnosed VWD I. In 36 patients possible VWD was found, 13 of these had normal results at the second visit while in 6 VWD became more likely. The main diagnosis was lupus-anticoagulant (n=79), normalizing in 24. A total of 88 children underwent surgery during the study period.
  
  
  CONCLUSIONS
  Our study shows frequent changes in the diagnosis and highlights the limitations of single laboratory tests in detecting mild BD. Clinical and laboratory abnormalities have to be followed and tests must be repeated in unclear cases. Normal values at one point do not exclude a BD.
authors: Department of Pediatric Hemostaseology, Dr. von Hauner's University Childrens Hospital, München, Germany. christoph.bidlingmaier@med.uni-muenchen.de
authors: C
authors: C
authors: Bidlingmaier
authors: J
authors: J
authors: Treutwein
authors: M
authors: M
authors: Olivieri
authors: K
authors: K
authors: Kurnik
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010314:Partial Thromboplastin Time / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014842:von Willebrand Diseases / Q000097:blood* / Q000175:diagnosis*