Hemostasis disorders in neonates – a practical approach
Authors:
K. Maťašová ml.; K. Maťašová; M. Zibolen
Published in:
Čes-slov Neonat 2024; 30 (2): 88-99.
Category:
Reviews
Overview
Hemostasis disorders in neonates – a practical approach
Bleeding is a frequent complication especially in premature neonates and it usually arises as a result of a hemostatic disorder. The platelet count and basic parameters of coagulation should always be a part of differential diagnosis of a bleeding neonate. However, the interpretation of the results in clinical practice is difficult. One of the reasons may be the insufficient knowledge of doctors about the specifics of hemostasis of newborns, that result in differences in laboratory results of neonates compared to adults. If the laboratory values are pathological, another problem is searching for an etiology due to very broad and difficult area of coagulation disorders and the limited availability of pediatric hematologists. The publication offers reference values of the basic parameters of coagulation in newborns, as well as practical guide to indicative differential diagnosis of hemostatic disorders in neonates based on the results of commonly available laboratory examinations.
Keywords:
Platelets – hemostasis – neonate – coagulation
Sources
- Achey MA, Nag UP, Robinson VL, et al. The developing balance of thrombosis and hemorrhage in pediatric surgery: Clinical implications of age-related changes in hemostasis. Clin Appl Thromb Hemost 2020; 26:1076029620929092. doi: 10.1177/1076029620929092.
- Araki S, Shirahata A. Vitamin K deficiency bleeding in infancy. Nutrients 2020; 12(3):780. doi: 10.3390/nu12030780.
- Cannata G, Mariotti Zani E, Argentiero A, et al. TEG® and ROTEM® traces: Clinical applications of viscoelastic coagulation monitoring in neonatal intensive care unit. Diagnostics (Basel) 2021; 11(9): 1642. doi:10.3390/diagnostics11091642.
- Caparrós Pérez E, Teruel Montoya R, Palma Barquero V, et al. Down regulation of the Munc18b-syntaxin-11 complex and β1-tubulin impairs secretion and spreading in neonatal platelets. Thromb Haemost 2017; 117(11): 2079−2091. doi: 10.1160/ TH17-04-0241.
- Cattivelli K, Diszefano C, Bonetti L, et al. Recurrent bleedings in newborn: A factor VII deficiency case report. Transfus Med Hemother 2018; 45(2): 104−106. doi: 10.1159/000481993.
- Davenport P, Sola Visner M. Hemostatic challenges in neonates. Pediatr 2021; 9: 627715. doi: 10.3389/fped.2021.627715.
- Deschmann E, Saxonhouse MA, Feldman HA, et al. Association between in vitro bleeding time and bleeding in preterm infants with thrombocytopenia. JAMA Pediatr 2019; 173(4): 393−394. doi: 10.1001/jamapediatrics.2019.0008.
- Gialamprinou D, Kontovazainitis CG, Pouliakis A, et al. Sepsis-induced coagulopathy in preterm neonates with Gram-positive sepsis presents with hypercoagulation and reduced platelet activation compared with healthy preterm neonates. Res Pract Thromb Haemost 2023; 7(2): 100100. doi: 10.1016/j. rpth.2023.100100.
- Gialamprinou D, Mitsiakos G, Katsaea GN, et al. Neonatal sepsis and hemostasis. Diagnostics (Basel) 2022; 12(2): 261. doi: 10.3390/diagnostics12020261.
- Gilmore LE, Chou ST, Ghavam S, et al. Consensus transfusion guidelines for a large neonatal intensive care network. Transfusion 2024; 64(8): 1562−1569. doi: 10.1111/trf.17914.
- Giouleka S, Tsakiridis I, Zachamitros D, et al. Fetal and neonatal alloimmune thrombocytopenia: A rare case report of prenatal treatment. Clin Case Rep 2023; 11(8): e7806. doi: 10.1002/ ccr3.7806.
- Go H, Ohto H, Nollet KE, et al. Risk factors and treatments for disseminated intravascular coagulation in neonates. Ital J Pediatr 2020; 46(1): 54. doi: 10.1186/s13052-020-0815-7.
- Hardy AT, Palma Barquero V, Watson SK, et al. Significant hyporesponsiveness to GPVI and CLEC-2 agonists in pre-term and full-term neonatal platelets and following immune thrombocytopenia. Thromb Haemost 2018; 118(6): 1009−1020. doi: 10.1055/s-0038-1646924.
- Iba T, Levy JH. Derangement of the endothelial glycocalyx in sepsis. J Thromb Haemost 2019; 17(2): 283−294. doi: 10.1111/ jth.14371.
- Javorka K, a kol. Lekárska fyziológia. Martin: Osveta 2021. ISBN 978-80-8063407-0.
- Kalagiri RR, ChoudhuryS, Carder R, et al. Neonatal thrombocytopenia as a consequence of maternal preeclampsia. AJP Rep 2016; 6(1): e42−e47. doi: 10.1055/s0035-1565923.
- Katsaras G, Gialamprinou D, Papacharalampous E, et al. Neonatal bleeding disorders. A practical diagnostic approach. Journal of Pediatric and Neonatal Individualized Medicine 2022; 11(2): e110231. doi: 10.7363/110231.
- Khalilov Zİ, Ünsal A, Altunaş N. The D-dimer reference intervals in healty term newborns. Transfus Apher Sci 2022; 61(6): 103493. doi: 10.1016/j.transci.2022.103493.
- Majid A, Blackwell M, Briadbent RS, et al. Newborn vitamin K prophylaxis: A historical perspective to understand modern barriers to uptake. Hosp Pediatr 2019; 9(1): 55−60. doi: 10.1542/ hpeds.2018-010.
- Martinod K, Deppermann C. Immunothrombosis and thromboinflammation in host defense and disease. Platelets 2021; 32(3): 314−324. doi: 10.1080/09537104.2020.1817360.
- Moisewitsch N, Brown AC. Neonatal coagulopathies: A review of established and emerging treatments. Exp Biol Med (Maywood) 2021; 6(12):1447−1457. doi: 10.1177/15353702211006046.
- Nellenbach KA, Nandi S, Kyu A, et al. Comparison of neonatal and adult fibrin clot properties between porcine and human plasma. Anesthesiology 2020; 132(5): 1091−1101. doi: 10.1097/ ALN.0000000000003165.
- Palma Barqueros V, Torregrosa JM, Caparrós Pérez E, et al. Developmental differences in platelet inhibition response to prostaglandin E1. Neonatology 2020; 117(1): 15−23. doi: 10.1159/000504173.
- Park, S. H., Choe, B. H. Moderate hemophilia B diagnosed by massive gastrointestinal hemorrhage on the first day of life: A case report and literature review. Neonatal Medicine 2016; 23(4): 238−241. doi: 10.5385/nm.2016.23.4.238.
- Saxonhouse MA, Garner R, Mammel L, et al. Closure times measured by the platelet function analyzer PFA-100 are longer in neonatal blood compared to cord blood samples. Neonatology 2010; 97(3): 242−249. doi: 10.1159/000253755.
- Semple JW, Kapur R. Protecting the fetus from FNAIT. Blood 2022; 140(20): 2097−2099. doi: 10.1182/blood.2022017937.
- Venkatesh V, Curley A, Khan R, et al. A novel approach to standardised recording of bleeding in a high risk neonatal population. Arch Dis Child Fetal Neonatal Ed 2013; 98(3): F260−F263. doi: 10.1136/archdischild2012-302443.
- Waller AK, Lantos L, Sammut A, et al. Flow cytometry for near-patient testing in premature neonates reveals variation in platelet function: A novel approach to guide platelet transfusion. Pediatr Res 2019; 85(6): 874−884. doi: 10.1038/s41390019-0316-9.
- Winkelhorst D, De Vos TW, Kamphuis MM, et al. HIP (HPA-screening in pregnancy) study: Protocol of a nationwide, prospective and observational study to assess incidence and natural history of fetal/neonatal alloimmune thrombocytopenia and identifying pregnancies at risk. BMJ Open 2020; 10(7): e034071. doi: 10.1136/bmjopen-2019-034071.
- Yadav D, Mahashwari A, Aneja S, et al. Neonatal Kasa- bach-Merritt phenomenon. Indian J Med Paediatr Oncol 2011; 32(4): 238−241. doi: 10.4103/09715851.95150.
Labels
Neonatology Neonatal NurseArticle was published in
Czech and Slovak Neonatology

2024 Issue 2
Most read in this issue
- Hemostasis disorders in neonates – a practical approach
- Transfusion therapy in neonatology
- Use of albumin in newborns
- Immune-related hemolytic anemia of newborns: pathophysiology and diagnosis