Coagulogram changes in children

In mature new-borned

Vascular-platelet hemostasis:

• platelet amount is like in bigger children and even in the adult;

• bleeding duration is like in the adult;

• platelet clot retraction is like in the adult;

• platelets morphology is like in the adult;

• adhesive function is like in the adult;

• aggregation activity is reduced to ADP, collagen, epinephrine (due to weakened releasing reaction, proaggregants decreasing in part thromboxan and prostaglandins).

Coagulation hemostasis:

• the XII-th factor level is equal to 20-70% from adult level (up to the 9-14^th days of life);

• prekallikrein level is reduced up to 20-50%;

• highly-molecular kininogen is lowered up to 40-80% of the adult level;

• thus, both blood coagulation and fibrinolysis are retarded;

• but even deep hypocoagulation is not accompanied by bleedings;

• this period distinguishing feature is vit K-dependent factors (II, VII, IX and X) lowering especially on the 3^rd and the 6^th days of life (they come to norm up to the 14^th day of life);

• early cutting of cord before so-called “placenta autotransfusion” id est blood pumping from placenta vessels into the child blood stream leads to bigger lowering in these vit K-dependent factors content;

• similarly, maternal breast early giving (during 2 first hours after birth) lowers significantly mentioned factors depression after birth comparatively to breast later giving (in 6-8 hours);

• antithrombin III level in plasma is lowered up to 50-69% and reaches its normal level up to the 6^th month;

• protein C and S contents are reduced significantly;

• plasminogen level is lowered up to 40-50% (up to the 6^th month);

• plasminogen activator level is increased during the 1^st 7 days;

• fibrinolysis activation is especially observed at cord cutting in 3-5 min (if right after birth – in less extent);

• if coagulation factors level is less than 10% than the child can be determined to the risk group on hemorrhagies;

• if coagulation factors content is more than 60% than the child can be determined to the risk group on thrombosis.

But one should remember that all mentioned features are physiological norm sign but not pathological one.

In immature new-borned:

• hemostasis bigger depression than in mature babies;

• lowering all procoagulants except fibrinogen and fibrinase;

• maximal hypocoagulative shift is observed during the 1^st day of life (in mature babies – during the 3^rd-5^th days);

• early hypocoagulation reason – physiological jaundice, factors deficient synthesis in liver;

• bigger deficiency of the XII-th;

• bigger deficiency of antithrombin III, protein C;

• bigger deficiency of fibrinolytic system components;

• all mentioned changes determine bigger rate both of hemorrhagic and thrombotic changes, more often DIC-syndrome development;

• increase up to the adult norm appears in different terms.

1-12-yeared children

• blood coagulation time reaches adult numbers up to an end of the 1^st year of life;

• platelets number – is like in the adult;

• but many junior thrombocytes (8-17%, in the adult – 4-5%);

• 7-8% - old platelets;

• 10-11% - atypic forms;

• prothrombin content is fluctuated more both in the side of increase and decrease;

• the V-th and VII-th factors level is reduced comparatively to the adults;

• thus, there is big variety in indexes and they do not reach adult norms.

The biggest varieties –during puberty.