Procoagulants and anticoagulants in fetal blood. A literature survey.

Abstract

Abstract:In intrauterine life, hemostasis is maintained by the same components as in extrauterine life (blood platelets, coagulation and fibrinolysis systems, involvement of the vascular wall); in the fetus, however, these components show significant differences of a quantitative/qualitative nature. In the present study, we surveyed the literature on the coagulation system in the fetus. We focused on the velocity of development of the coagulation system, being reflected in the increased concentration of all procoagulants and anticoagulants (a rise from approximately 20% in the middle of pregnancy to about 60% or more in the period of labor; exceptions: factors V,VIII and XIII which in the labor period reach the adult level) and screening test results (prothrombin time, aPTT -activated prothrombin time, and thrombin time). Reference values were given for the 19-38 weeks of pregnancy and the labor term. Biochemical features of fetal fibrinogen and PIVKA factors were also discussed. The role of activated protein C (APC) in the maintenance of balance between procoagulants and anticoagulants was postulated as well as the role of APC in the formation of thrombin activatable fibrinolysis inhibitor (TAFI).

Coagulation and the surgical neonate

“…By 11 weeks, blood can clot. Levels of most pro‐ and anticoagulant proteins are low in the fetus , and proteins may be present in immature forms . Levels increase during pregnancy (in particular around 34 weeks postgestational age) and then again at birth, but remain (with some exceptions) below adult levels during infancy and in some cases beyond .…”