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Age dependency for coagulation parameters in paediatric populations. Results of a multicentre study aimed at defining
Pierre Toulon1, Micheline Berruyer, Marie Brionne-François
1Dr. Pierre Toulon, CHU Nice, Hôpital Pasteur, Service d'Hématologie Biologique, 30, avenue de la Voie Romaine, CS 51069, F-06001 Nice Cedex 1, France, Tel.: + 33 4 92 03 87 09, Fax: + 33 4 92 03 85 95,
Insights
Pediatric coagulation test results vary significantly with age, especially in the first year of life. Establishing age-specific reference ranges is crucial for accurate diagnosis and treatment of bleeding and clotting disorders in children.
Area of Science:
- Pediatric Hematology
- Hemostasis and Thrombosis
- Clinical Coagulation
Background:
- Developmental hemostasis understanding is vital for managing pediatric hemorrhagic and thrombotic diseases.
- Coagulation test results are influenced by reagents and analyzers, necessitating laboratory-specific reference ranges.
- Standardized methods are needed to establish reliable age-dependent reference ranges in pediatric populations.
Purpose of the Study:
- To establish age-specific reference ranges for coagulation tests in pediatric patients.
- To evaluate age-related variations in clotting factors, inhibitors, and fibrinolysis markers.
- To emphasize the importance of age-specific reference ranges for accurate clinical interpretation.
Main Methods:
- Coagulation tests were performed on plasma samples from 1437 pediatric patients across six age groups.
- The study utilized standardized reagents and analyzers across seven participating centers.
- Patient data included age, clinical indication for testing (primarily pre-operative screening), and various coagulation parameters.
Main Results:
- Prothrombin time (PT) values were comparable to adults, while activated partial thromboplastin time (aPTTT) was longer in younger children.
- Most clotting factors (except FV), antithrombin, protein C/S, and plasminogen levels were decreased in infants, reaching adult levels by one year.
- Fibrinogen, Factor VIII (FVIII), von Willebrand factor (VWF), and D-dimer levels were elevated in infants, normalizing within six months to puberty.
Conclusions:
- Coagulation test results in children are highly age-dependent, particularly during the first year of life.
- Age-specific reference ranges are essential for the accurate evaluation of hemostasis in pediatric patients.
- Implementing age-specific ranges improves the diagnosis and management of bleeding and clotting disorders in children.
Abstract:
Understanding of developmental haemostasis is critical to ensure optimal prevention, diagnosis, and treatment of haemorrhagic and thrombotic diseases in children. As coagulation test results are known to be dependent on the reagents/analysers used, it is recommended for each laboratory to define the age-dependent reference ranges by using its own technical condition. That study was carried out in seven centers to establish age-specific reference ranges using the same reagents and analyser. Plasma samples were obtained from 1437 paediatric patients from the following age groups: 15 days-4 weeks (n=36), 1-5 months (n=320), 6-12 months (n=176), 1-5 years (n=507), 6-10 years (n=132) and 11-17 years (n=262). Indication of coagulation testing was pre-operative screening for non-acute diseases in most cases. PT values were similar in the different age groups to those in adults, whereas longer aPTTs were demonstrated in the younger children. Plasma levels of all clotting factors, except for FV, were significantly decreased (p<0.0001) in the youngest children, adult values being usually reached before the end of the first year. The same applied to antithrombin, protein C/S, and plasminogen. In contrast, FVIII and VWF levels were elevated in the youngest children and returned to adult values within six months. The same applied to D-dimer levels, which were found elevated, particularly until six months of life, until puberty. These data suggest that most coagulation test results are highly dependent on age, mainly during the first year of life, and that age-specific reference ranges must be used to ensure proper evaluation of coagulation in children.
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