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The clinical relevance of factor VIII: C and factor VII R: Ag determination in newborns
Insights
Newborns exhibit higher factor VIII levels than adults, potentially due to birth stress. Illness exacerbates these levels, impacting coagulation factor turnover and diagnosis.
Area of Science:
- Neonatal physiology
- Hematology
- Pediatric critical care
Background:
- Coagulation factor levels, specifically factor VIII: C (activity) and factor VIII R: Ag (antigen), differ between newborns and adults.
- Birth and extrauterine adaptation represent significant physiological stressors for newborns.
- Disease states in newborns can further influence coagulation parameters.
Purpose of the Study:
- To investigate factor VIII: C and factor VIII R: Ag levels in healthy and ill newborns compared to adults.
- To explore the relationship between stress, disease, and coagulation factor dynamics in neonates.
- To assess the diagnostic utility of factor VIII ratios in neonatal critical illness.
Main Methods:
- Comparative analysis of factor VIII: C and factor VIII R: Ag levels.
- Inclusion of healthy newborns (n=60), ill newborns (n=32), and severely ill newborns (n=21).
- Evaluation of the ratio of factor VIII: C/VIII R: Ag in different neonatal groups.
Main Results:
- Healthy newborns showed higher factor VIII: C and factor VIII R: Ag than adults.
- Ill and severely ill newborns presented the highest factor VIII R: Ag values.
- Increased ranges of factor VIII: C and the ratio factor VIII: C/VIII R: Ag were observed in ill newborns, indicating heightened coagulation factor turnover.
- Consumption of factor VIII: C with a low ratio predominated in extremely ill newborns, suggesting disseminated intravascular coagulation (DIC).
Conclusions:
- Elevated factor VIII levels in newborns are likely stress-related.
- The ratio of factor VIII: C/VIII R: Ag is a valuable indicator for diagnosing DIC in newborns.
- Diagnosing hemophilia and von Willebrand's disease in severely ill newborns is challenging due to confounding factors like stress and DIC.
Abstract:
Higher levels of factor VIII: C and factor VIII R: Ag were found in healthy newborns (n = 60) as compared to adults. This could be explained as a stress reaction due to birth and the adaptation to extrauterine life. A further stress factor is disease. The highest values for factor VIII R: Ag were found in ill (n = 32) and in severely ill newborns (n = 21). The large ranges of factor VIII: C and of the ratio of factor VIII: C/VIII R: Ag in healthy newborns can be explained by an increased turnover of coagulation factors. Diseases in the newborn period lead to an increase of this process, resulting in even larger ranges of factor VIII: C and of the ratio of factor VIII: C/VIII R: Ag in ill and extremely ill newborns. Consumption of factor VIII: C with a low ratio of factor VIII: C/VIII R: Ag predominates in extremely ill newborns. The ratio of factor VIII: C/VIII R: Ag is more valuable than factor VIII: C for diagnosis of DIC in newborns. A diagnosis of hemophilia and von Willebrand's disease cannot be established with certainty in severely ill newborns. Stress and DIC may influence the characteristic changes of laboratory parameters.