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PFA-100 closure times in preoperative screening in 500 pediatric patients
Birgit Roschitz1, Sigrid Thaller, Martin Koestenberger
1Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 30, 8036 Graz, Austria.
Insights
The PFA-100 test is useful for screening von Willebrand disease (vWD) in children with suspected bleeding disorders. However, it should not be used for general preoperative screening due to questionable added value in identifying primary hemostatic defects.
Area of Science:
- Hematology
- Pediatric Surgery
- Diagnostic Screening
Background:
- Preoperative screening for hemostatic defects is crucial for surgical patients.
- Acquired or congenital platelet defects and von Willebrand disease (vWD) affect 3-5% of surgical patients.
- The predictive value of standard coagulation screening is debated.
Purpose of the Study:
- To evaluate the PFA-100's effectiveness in identifying primary hemostatic defects in pediatric surgical outpatients.
- To determine if PFA-100 screening leads to unnecessary abnormal lab values and surgical delays.
Main Methods:
- A prospective study of 500 children undergoing surgery.
- Collected data included complete blood count, activated partial thromboplastin time (aPTT), and PFA-100 closure times (CT).
- Patients with abnormalities underwent further testing, including von Willebrand factor antigen (vWF:AG), ristocetin cofactor (R:Cof), and factor VIII levels.
Main Results:
- 25.2% of patients (126/500) had abnormal aPTT and/or PFA-100 results.
- Further investigation of 89 patients revealed no specific diagnosis or impaired hemostasis criteria.
- The PFA-100 identified 10 out of 12 patients with low vWF:AG, including 4 with normal aPTT.
Conclusions:
- The PFA-100, similar to aPTT, is most effective as a screening tool when a hemostatic defect is clinically suspected, particularly for von Willebrand disease (vWD).
- Unselective general screening with PFA-100 may not be beneficial and could lead to unnecessary investigations and delays.
Abstract:
Three to five percent of patients undergoing surgery have either an acquired or congenital platelet defect or von Willebrand disease (vWD). The predictive value of preoperative coagulation screening is questionable. PFA-100 is now routinely used in preoperative screening in our pediatric outpatient service. We wanted to assess whether the PFA-100 would help to identify patients with primary haemostatic defects or if the additional use of PFA-100 would add to the problem of unnecessary pathologic preoperative laboratory values resulting in delay of surgical procedure. We investigated 500 children consecutively seen in our outpatient service before surgery. Blood cell count, aPTT, PFA-100 closure times (CT) were done in all patients. If abnormalities were found, the patient was presented to a haemostatic expert. vWF:AG, R:Cof and factor VIII were analysed in all patients with prolonged closure times and APTT values. One hundred twenty-six patients (25.2%) showed abnormalities in APTT and/or PFA-100. Further investigations in 89 of these 126 patients did not yield a specific diagnosis; neither diagnostic criteria for impaired haemostasis were found by questionnaire. None of these 89 patients had a bleeding complication during surgery. Forty-eight patients showed prolonged CTs. Twelve patients with low vWF:AG were detected, 10 of these patients were found by PFA-100. Four of these patients did present with normal APTT values. Our study shows that similar to the APTT the PFA-100 is probably only a good screening method when a haemostatic defect in a patient is clinically likely, especially to screen forVWD, and the test should not be used in general unselective screening.
