Age dependency of coagulation parameters during childhood and puberty

Abstract

To cite this article: Appel IM, Grimminck B, Geerts J, Stigter R, Cnossen MH, Beishuizen A. Age dependency of coagulation parameters during childhood and puberty. J Thromb Haemost 2012; 10: 2254-63.Summary. Background: Use of age-adjusted reference values is crucial for correct diagnosis and management of thrombotic and hemorrhagic disease in children. They vary with utilized reagents and analyzers. Objectives: We established reference values with the Sysmex CA-1500 System and in parallel with the Behring BCS System using reagents from Siemens Healthcare Diagnostics Products GmbH. Methods: After informed consent, blood samples were obtained from 218 healthy children and 52 healthy adults, grouped as 1-6 months (n = 29), 7-12 months (n = 25), 1-5 years (n = 57), 6-10 years (n = 57), 11-18 years (n = 50) and > 19 years (n = 52). Results: Most coagulation parameters demonstrate good comparability between analyzers with the exception of PT and APTT. Single coagulation factors fibrinogen, factor (F) II, FIX, FXI and XII were significantly decreased in the youngest children; the strongest age dependency was found for coagulation inhibitors Protein C and S, both significantly decreased in infancy and young childhood. We confirmed that high levels of von Willebrand factor are found in the youngest children without increased levels of FVIII followed by decreased von Willebrand levels in the subsequent age group. In children with blood group O a less distinct increase in time was found, compared with individuals with one of the other blood groups. Conclusions: The correlation between the CA-1500 and the BCS system was remarkable. Differences were most pronounced between children < 12 months and older children and adults, confirming the phenomenon of developmental hemostasis. The rationale for age-related changes in the hemostatic system remains unraveled. Our results underline the need for age-specific reference ranges.

Establishing reference intervals in the coagulation laboratory

“…However, highest levels of vWF are seen in the youngest children, but without increased levels of FVIII. This study supported the theory of developmental hemostasis where differences were most pronounced in children <12 months of age …”

Low Serum Fetuin-A as a Biomarker to Predict Pneumococcal Necrotizing Pneumonia and Hemolytic Uremic Syndrome in Children

“…Coagulation parameters prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen were analyzed in some patients, wherever indicated, using Sysmex CA-1500 System from Sysmex Corporation (Kobe, Japan). 16 Normal references for age were obtained from the Nelson Textbook of Pediatrics. 17 The presence of normal fibrinogen levels in the diagnostic criteria for HUS was used to rule out DIC.…”

Paediatric reference intervals for common coagulation assays in Chinese children as performed on the STA‐R coagulation analyzer

“…For aPTT, all paediatric age groups had higher median values than those of adults. The prolonged aPTT values in the paediatric population may be explained by markedly decreased levels of the vitamin K‐dependent clotting factors such as Factor IX (FIX) . The prolonged aPTT values may also be related to FXI, FXII, and prekallikrein .…”

“…Actually, the paediatric haemostatic balance differs from that in adults due to continuous changes of biological development. The concept of developmental homeostasis suggesting that the haemostatic system changes and matures throughout the time from foetal to adult life, particularly in the first few months of life, has been universally accepted . Accurate and reliable paediatric reference intervals play an important role in clinical diagnosis and therapy of haemorrhagic and thrombotic diseases.…”

“…life, has been universally accepted. [2][3][4] Accurate and reliable paediatric reference intervals play an important role in clinical diagnosis and therapy of haemorrhagic and thrombotic diseases. Especially in children, reference intervals may vary significantly with age.…”