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Paul Monagle, Chris Barnes, Vera Ignjatovic, Janine Furmedge, Fiona Newall, Anthony Chan, Lidia De Rosa, Simone Hamilton, Philip Ragg, Stephen Robinson, Alex Auldist, Cathy Crock, Neil Roy, Shelley Rowlands
Developmental haemostasis. Impact for clinical haemostasis laboratories
Keywords: Reference ranges, developmental haemostasis, paediatric
Developmental haemostasis is a concept, now universally accepted, introduced by Andrew et al. in the late 1980s. 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.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 95
Pages: 362 - 372