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Functional maturity of the coagulation system in children: an evaluation using thrombelastography
B E Miller1, J M Bailey, T J Mancuso
1Department of Anesthesiology, Emory University School of Medicine and Egleston Children's Hospital, Atlanta, Georgia 30322, USA.
Insights
Pediatric coagulation is functionally intact despite quantitative deficiencies in early life. Thrombelastography (TEG) shows that even neonates initiate and develop clots faster than adults, with adult rates achieved after one year.
Area of Science:
- Pediatric Anesthesiology
- Hemostasis and Thrombosis
- Pediatric Surgery
Background:
- Neonates and infants exhibit quantitative deficiencies in coagulation factors.
- Clinical observations suggest no increased bleeding risk in pediatric surgical patients.
- Functional assessment of pediatric coagulation is crucial for surgical safety.
Purpose of the Study:
- To assess the hemostatic system in pediatric patients using thrombelastography (TEG).
- To evaluate coagulation function in healthy children under two years of age.
- To establish pediatric control TEG values for future research.
Main Methods:
- Thrombelastography (TEG) was performed on 237 healthy pediatric patients (<2 years).
- Patients were categorized into five age groups: <30 days, 1-3 months, 3-6 months, 6-12 months, and 12-24 months.
- TEG data were compared between age groups and with adult values.
Main Results:
- TEG revealed no coagulation defects in pediatric groups compared to each other or adults.
- Infants under 12 months initiated and developed clots faster than adults.
- Coagulation parameters approached adult levels after 1 year of age.
Conclusions:
- The pediatric hemostatic system is functionally intact in the first year of life.
- Faster clot initiation and development in infants suggest a robust hemostatic capacity.
- This study provides essential pediatric TEG reference values for understanding perioperative coagulation.
Abstract:
There are quantitative deficiencies in the coagulation system for at least the first 6 mo of life. Clinical experience, however, does not indicate an increased risk of excessive bleeding during surgical procedures. Thrombelastography, a test providing a functional evaluation of coagulation, was used to assess the hemostatic system of pediatric patients under 2 yr of age. Thrombelastographic data were obtained from 237 healthy pediatric patients less than 2 yr of age undergoing elective noncardiac surgery. Five groups were distinguished: under 30 days, 1-3 mo, 3-6 mo, 6-12 mo, and 12-24 mo. Thrombelastography revealed no defects in coagulation when these groups were compared to each other or to adults, indicating a functionally intact hemostatic process even in neonates. Indeed, children less than 12 mo of age were found to initiate and develop clot faster than adults, with the coagulation process slowing to adult rates after 1 yr of age. In addition to defining functional integrity, our data represents a set of pediatric control thrombelastographic values that have not been previously reported and that may become important in understanding coagulation changes that accompany disease states and surgery in pediatric patients.