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The importance of incidentally detected coagulation abnormalities in children
Gökçen Meral1, Ayça Koca Yozgat2, Vildan Çulha2
1Department of Pediatrics, Ankara City Hospital, Cankaya, Turkey.
Insights
Mild coagulation factor deficiencies are more common than anticipated in children with incidentally prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). These mild deficiencies often present without a bleeding history, and their clinical significance remains unclear.
Area of Science:
- Pediatric Hematology
- Hemostasis and Thrombosis
- Clinical Coagulation
Background:
- A thorough history and physical examination typically identify most bleeding disorders.
- This study investigated hemostatic disorders in pediatric patients with incidentally prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT).
Purpose of the Study:
- To identify the prevalence and types of hemostatic disorders in pediatric patients with incidental PT/aPTT prolongation.
- To assess the clinical significance of mild factor deficiencies in this population.
Main Methods:
- Pediatric patients with incidental prolonged PT and/or aPTT, without prior hematologic disease, were enrolled.
- Coagulation factor activities were analyzed. Antiphospholipid antibodies and lupus anticoagulant tests were performed for patients with abnormal mixing studies.
Main Results:
- Of 103 patients, 50 had persistent PT/aPTT abnormalities upon re-testing.
- Coagulopathy was identified in 30% of the total cohort (60% of those with persistent abnormalities).
- The most frequent deficiencies included Factor XII (5.8%), Factor XI (4.8%), and Factor VII (2.9%).
Conclusions:
- Mild coagulation factor deficiencies are more prevalent than expected in children with incidental PT/aPTT prolongation.
- These mild deficiencies can occur in patients without a bleeding history.
- The clinical significance and implications of these mild factor deficiencies are often unknown.
Background:
A history and physical examination can predict most bleeding disorders. This study aimed to reveal possible hemostatic disorders in patients referred to the pediatric hematology department due to the incidentally detected prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT).
Methods:
Pediatric patients without known hematologic disease and referred to investigate the incidental prolonged PT and/or aPTT were included. Coagulation factor activities were analyzed in these patients; antiphospholipid antibodies and lupus anticoagulant tests were studied in patients with abnormal mixing results.
Results:
A total of 103 patients were included in the study, but in re-evaluation, fifty-three children repeated tests were normal. Further examinations were done for 50 children whose PT/aPTT abnormality persisted in repeated tests. Seventeen patients presented with isolated prolonged PT, twenty-seven patients presented with isolated prolonged aPTT, and six patients with both prolonged PT and aPTT. Coagulopathy was found in 31 (30%) of the whole cohort, which was 60% of patients with persistent abnormal tests. The most common deficient factors were FXII (5.8%), FXI (4.8%), FVII (2.9%), FV (0.9%), FVIII (0.9%), fibrinogen with FVII deficiency (0.9%), and von Willebrand factor (vWF) deficiency (0.9%).
Conclusion:
According to the results of our study in patients presenting with incidental PT and/or aPTT prolongation, mild factor deficiencies are more common than expected. Mild coagulation factor deficiencies can be seen in patients without any bleeding history. There is often no evidence of bleeding in mild factor deficiencies, and their clinical significance is unknown.
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