title: Thrombin generation test in children and adolescents with chronic liver disease.
abstract: BACKGROUND
  The aim of this study was to evaluate if real-time thrombin generation assay provides additional information to assess the hemostatic balance in children with liver disease as compared to routine coagulation tests.
  
  
  METHODS
  Sixty-three children with chronic liver disease were enrolled at our tertiary referral center for pediatric hepatology, eight whose routine coagulation tests gave abnormal results (Group A) and 55 whose test results were normal (Group B). Abnormal routine coagulation test was defined as at least one of the following: international normalized ratio≥1.4, activated partial thromboplastin time>44 sec., fibrinogen<1.5 g/L. Platelet-poor plasma was analyzed with the fluorogenic Calibrated Automated Thrombogram to test for thrombin generation, including endogenous thrombin potential. Further, routine coagulation tests and plasma levels of pro- and anticoagulant factors were measured. Twenty age-matched children without liver disease served as controls.
  
  
  RESULTS
  The endogenous thrombin potential in the 55 patients with normal routine coagulation tests was not significantly different from that in controls. Group A had significantly lower levels not only of procoagulant factors (II, V, VII, X) but simultaneously also of the anticoagulant factors antithrombin, protein S free, and protein C. These patients had a reduced endogenous thrombin potential compared to Group B, in agreement with their routine coagulation test results.
  
  
  CONCLUSIONS
  Thrombin generation analysis seems to give information on the hemostatic balance consistent with routine coagulation test results in children with liver disease. Further development and clinical evaluation of the method are warranted.
authors.affiliation: CLINTEC, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-141 86 Stockholm, Sweden. Electronic address: maria.magnusson@ki.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Magnusson
authors.affiliation: Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Berndtsson
authors.affiliation: CLINTEC, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Fischler
authors.affiliation: Department of Woman and Child Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Petrini
authors.affiliation: Department of Medicine, McMaster University, HHS - 237, Barton Street East, Hamilton, ON L8L 2X2, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
authors.affiliation: Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; Institute for Clinical Chemistry, University Hospital Eppendorf, D-20246, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Renne
authors.affiliation: CLINTEC, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Granath
authors.affiliation: Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Sten-Linder
authors.affiliation: CLINTEC, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.
authors.forename: Antal
authors.initials: A
authors.lastname: Németh
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood*; D008297:Male; D013918:Thrombin Time / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult
keywords: Bleeding; Child; Coagulation; Endogenous thrombin potential; Liver; Pediatric