Hemostasis in the Neonate

Marilyn J. Manco Johnson

Presented : Rusdi Arief

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Introduction
Fetal and neonatal hemostasis is
unique features.
Coagulation must be finely to prevent
excessive blood loss.
Hemorrhage and thrombosis are rare
in the healthy term infant.

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Physiology of coagulation

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Thrombin activities,

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The fibrinolytic system

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Characteristics unique to the fetal
and neonatal hemostatic system
Deletion of genes for antithrombin, TF,
TFPI, FV, prothrombin are lethal.
Deletion of genes in thrombin
propagation and fibrinolysis do not
result in excess fetal mortality.
TF distributed limited.
TF functions are tissue proliferation
and differentiation.
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Continue
Contact factors, prekalikrein, HMW
kininogen, FXIII, FIX also display
delayed maturation.
Plasma of preterm infants displays
rapid rate of thrombin.
Total amount of thrombin generated is
decreased correlated with prothrombin
concentration.

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Continue
Plasma clot has decreased fibril length
and prolonged time to clotting.
Newborn has a low plasminogen
concentration.
Fetal form plasminogen exhibits 20%
active site.

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Continue
3% of healthy term infants show
noncarboxylated prothrombin.
Without vit.K supplementation 1:1000
infants cause bleeding, 1:10.000
suffered from hemorrhagic disease.

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Proteins involved in maintaining
hemostasis.

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Result of Coagulation Test in Term
and Preterm Infants
PTT of the newborn is prolonged.
PTT may not achieve normal values
until 6 months.
Thrombin time is prolonged about
30%.
Fibrinogen concentration should be
normal even on extreme preterm
infants.
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Fibrinogen < 100 mg/dl and platelet <
100x103/mcL are pathologic process.
The increasing of Hct contributes to
increase whole blood coagulability.
Plasma coagulability test show
delayed formation of plasma clots.
Euglobulin clot lysis time show short
lysis time.
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FVIII concentration is within normal
limit, easier to diagnose Haemophilia
A.
FIX can be reach 15U/dL, making the
distinction between normal and mild
Haemophilia B.
Newborn have VWF higher than adult,
mild type 1 Von Willebrand disease
cannot be excluded.
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