Analysis of Children with Coagulation Test Abnormality in Pre-Surgical Evaluation

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4080-4080
Author(s):  
Seung Yeon Kwon ◽  
Jung Woo Han ◽  
Sung Chul Won ◽  
Jaewoo Song ◽  
Chuhl Joo Lyu
Keyword(s):  
Surgical Procedures ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
Factor Vii ◽  
Factor Xii ◽  
Surgical Evaluation ◽  
Bleeding History ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract Prothrombine time (PT) and activated prothrombine time (aPTT) are common tests used for screening of coagulation function before surgical procedures. We analyzed underlying causes of abnormal coagulation test results which were incidentally found during pre-surgical evaluation in healthy patients without definite bleeding history. Total 58 children referred to pediatric hematoloy service for abnormal PT and aPTT results in pre-surgical evaluation between June 2006 and May 2008 were analyzed retrospectively by review of medical records. 50 patients showed aPTT prolongation, 5 patients PT prolongation, 2 patients PT and aPTT prolongation and another three patients showed normal PT and aPTT. Among 55 patients with abnormal results, 25 patients (43%) were recovered spontaneously during their follow up tests, 17 patients (29%) showed lower level of certain coagulation factor than reference range and the other 13 patients were lost during follow up despite of recommendation for further evaluation. Mean value of international normalized ratio (INR) for PT and aPTT of the patients recovered spontaneously were 1.05±0.11, 44.53±5.01seconds(s), and 1.12±0.11, 47.0±5.36s in patients with lower level of coagulation factor, showing significant increase of PTT in patients with lower factor levels (p<0.05). Median time required for spontaneous recovery was four weeks and 18 patients (72%) were recovered within this time. Among 17 patients with lower level of certain coagulation factor then reference level, there were 11 patients with low factor XII level, three patients with low factor VIII level, three patients with low von Willebrand factor, two patients each for low factor VII and factor XI and one patient with low factor V level. Among them three patients with low level in von Willebrand factor, one patient with low factor VII and two patients with low factor XI showed deficient level of coagulation factors requiring factor replacement for the surgical procedures. From this analysis of patients with incidentally found PT or aPTT prolongation, 43% of patients were spontaneously recovered during follow up period within 4 weeks in median. However, we also found that 29% of patients had relatively lower level of coagulation factor than reference range. Even though most of them were factor XII decrease which is not closely related with bleeding tendency, six patients had significant deficiencies of coagulation factors requiring factor replacement during surgical procedures. These results suggest that we should keep following up and undergo adequate evaluation for underlying coagulation factor deficiencies in patients who have sustaining PT and aPTT prolongation abnormalities despite of absence of any bleeding history.

scholarly journals Familial Multiple Coagulation Factor Deficiencies (FMCFDs) in a Large Cohort of Patients—A Single-Center Experience in Genetic Diagnosis

2021 ◽  
Vol 10 (2) ◽  
pp. 347
Author(s):  
Barbara Preisler ◽  
Behnaz Pezeshkpoor ◽  
Atanas Banchev ◽  
Ronald Fischer ◽  
Barbara Zieger ◽  
...  
Keyword(s):  
Genetic Analysis ◽  
Single Gene ◽  
Genetic Defect ◽  
Genetic Diagnosis ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
Molecular Genetic Analysis ◽  
Factor Vii ◽  
Factor Xii ◽  
Activity Levels

Background: Familial multiple coagulation factor deficiencies (FMCFDs) are a group of inherited hemostatic disorders with the simultaneous reduction of plasma activity of at least two coagulation factors. As consequence, the type and severity of symptoms and the management of bleeding/thrombotic episodes vary among patients. The aim of this study was to identify the underlying genetic defect in patients with FMCFDs. Methods: Activity levels were collected from the largest cohort of laboratory-diagnosed FMCFD patients described so far. Genetic analysis was performed using next-generation sequencing. Results: In total, 52 FMCFDs resulted from coincidental co-inheritance of single-factor deficiencies. All coagulation factors (except factor XII (FXII)) were involved in different combinations. Factor VII (FVII) deficiency showed the highest prevalence. The second group summarized 21 patients with FMCFDs due to a single-gene defect resulting in combined FV/FVIII deficiency or vitamin K–dependent coagulation factor deficiency. In the third group, nine patients with a combined deficiency of FVII and FX caused by the partial deletion of chromosome 13 were identified. The majority of patients exhibited bleeding symptoms while thrombotic events were uncommon. Conclusions: FMCFDs are heritable abnormalities of hemostasis with a very low population frequency rendering them orphan diseases. A combination of comprehensive screening of residual activities and molecular genetic analysis could avoid under- and misdiagnosis.

scholarly journals Coagulation profile of human COVID-19 convalescent plasma

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Allan M. Klompas ◽  
Noud van Helmond ◽  
Justin E. Juskewitch ◽  
Rajiv K. Pruthi ◽  
Matthew A. Sexton ◽  
...  
Keyword(s):  
Coagulation Factor ◽  
Protein S ◽  
Coagulation Factors ◽  
Fresh Frozen Plasma ◽  
Thrombin Time ◽  
Fresh Frozen ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Plasmin Inhibitor ◽  
Frozen Plasma

AbstractConvalescent plasma is used to treat COVID-19. There are theoretical concerns about the impact of pro-coagulant factors in convalescent plasma on the coagulation cascade particularly among patients with severe COVID-19. The aim of this study was to evaluate the coagulation profile of COVID-19 convalescent plasma. Clotting times and coagulation factor assays were compared between fresh frozen plasma, COVID-19 convalescent plasma, and pathogen-reduced COVID-19 convalescent plasma. Measurements included prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, D-dimer, von Willebrand factor activity, von Willebrand factor antigen, coagulation factors II, V, VII–XII, protein S activity, protein C antigen, and alpha-2 plasmin inhibitor. Clotting times and coagulation factor assays were not different between COVID-19 convalescent plasma and fresh frozen plasma, except for protein C antigen. When compared to fresh frozen plasma and regular convalescent plasma, pathogen reduction treatment increased activated partial thromboplastin time and thrombin time, while reducing fibrinogen, coagulation factor II, V, VIII, IX, X, XI, XII, protein S activity, and alpha-2 plasmin inhibitor. The coagulation profiles of human COVID-19 convalescent plasma and standard fresh frozen plasma are not different. Pathogen reduced COVID-19 convalescent plasma is associated with reduction of coagulation factors and a slight prolongation of coagulation times, as anticipated. A key limitation of the study is that the COVID-19 disease course of the convalesced donors was not characterized.

Periodontal Disease and Biomarkers Related to Cardiovascular Disease

2004 ◽  
Vol 83 (2) ◽  
pp. 151-155 ◽  
Author(s):  
K.J. Joshipura ◽  
H.C. Wand ◽  
A.T. Merchant ◽  
E.B. Rimm
Keyword(s):  
Cardiovascular Disease ◽  
Periodontal Disease ◽  
Factor Vii ◽  
Reactive Protein ◽  
Final Sample ◽  
Tissue Plasminogen ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Necrosis Factor

Periodontal disease is a chronic infection of the gums characterized by a loss of attachment between the tooth and bone, and by bone loss. We evaluated cross-sectionally the association between periodontal disease and C-reactive protein (CRP), fibrinogen, factor VII, tissue plasminogen activator (t-PA), LDL-C, von Willebrand factor, and soluble tumor necrosis factor receptors 1 and 2. The final sample consisted of 468 men (ages 47–80 yrs), participating in the Health Professional Follow-up Study, who provided blood and were free of CVD, diabetes, and cancer. In multivariate regression models controlling for age, cigarette smoking, alcohol intake, physical activity, and aspirin intake, self-reported periodontal disease was associated with significantly higher levels of CRP (30% higher among periodontal cases compared with non-cases), t-PA (11% higher), and LDL-C (11% higher). Based on our data, periodontal disease showed significant associations with biomarkers of endothelial dysfunction and dyslipidemia, which may potentially mediate the association between periodontal and cardiovascular disease.

scholarly journals Cold-induced contact surface activation of the prothrombin time in whole blood

Blood ◽  
1982 ◽  
Vol 59 (1) ◽  
pp. 38-42 ◽  
Author(s):  
RN Palmer ◽  
HR Gralnick
Keyword(s):  
Prothrombin Time ◽  
Whole Blood ◽  
Room Temperature ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
Factor Vii ◽  
Factor Xii ◽  
Contact Phase ◽  
Fletcher Factor ◽  
Esterase Inhibitor

Abstract Studies of the prothrombin time (PT) have revealed that contact with borosilicate or commercial siliconized borosilicate markedly shortens the PT. This shortening is related to the activation of the contact phase of blood coagulation. This shortening of the PT occurs in both normal whole blood and plasma when stored in borosilicate or siliconized borosilicate tubes at 4 degree C and to a lesser degree at room temperature. Studies indicated the importance of several coagulation factors in decreasing the PT. The PT did not change in blood deficient in factor XII or in plasma deficient in Fletcher factor or high molecular weight kininogen, while blood deficient in CI esterase inhibitor (CI INH) had the most profound shortening. Shortening of the PT correlated directly with increased levels of factor VII. When purified CI INH was added to normal blood, it markedly reduced the activation of factor VII and the shortening of the PT in a dose-related manner. These studies indicate the pivotal roles of the contact phase of coagulation in initiating activation of the PT and of CI INH in inhibiting the activation of the coagulation factor(s) responsible for the cold-promoted activation of factor VII.

scholarly journals Cold-induced contact surface activation of the prothrombin time in whole blood

Blood ◽  
1982 ◽  
Vol 59 (1) ◽  
pp. 38-42
Author(s):  
RN Palmer ◽  
HR Gralnick
Keyword(s):  
Prothrombin Time ◽  
Whole Blood ◽  
Room Temperature ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
Factor Vii ◽  
Factor Xii ◽  
Contact Phase ◽  
Fletcher Factor ◽  
Esterase Inhibitor

Studies of the prothrombin time (PT) have revealed that contact with borosilicate or commercial siliconized borosilicate markedly shortens the PT. This shortening is related to the activation of the contact phase of blood coagulation. This shortening of the PT occurs in both normal whole blood and plasma when stored in borosilicate or siliconized borosilicate tubes at 4 degree C and to a lesser degree at room temperature. Studies indicated the importance of several coagulation factors in decreasing the PT. The PT did not change in blood deficient in factor XII or in plasma deficient in Fletcher factor or high molecular weight kininogen, while blood deficient in CI esterase inhibitor (CI INH) had the most profound shortening. Shortening of the PT correlated directly with increased levels of factor VII. When purified CI INH was added to normal blood, it markedly reduced the activation of factor VII and the shortening of the PT in a dose-related manner. These studies indicate the pivotal roles of the contact phase of coagulation in initiating activation of the PT and of CI INH in inhibiting the activation of the coagulation factor(s) responsible for the cold-promoted activation of factor VII.

Coagulation factors in citrated plasma predict for benefit from bevacizumab (B) in patients with advanced pancreatic cancer (APC): Results from CALGB 80303 (Alliance).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 306-306
Author(s):  
Jeffrey Melson Clarke ◽  
Herbert Pang ◽  
Mark D. Starr ◽  
Ace Joseph Hatch ◽  
Hedy Lee Kindler ◽  
...  
Keyword(s):  
Cox Model ◽  
Advanced Pancreatic Cancer ◽  
Predictive Biomarkers ◽  
Coagulation Factors ◽  
Matrix Remodeling ◽  
Plasma Samples ◽  
Significant Difference ◽  
Von Willebrand ◽  
Willebrand Factor

306 Background: CALGB 80303 evaluated gemcitabine (G) in combination with either B or placebo (P) in 602 patients (pts) with APC. No significant difference in overall survival (OS) between treatment arms was observed. Previously, plasma EDTA samples from CALGB 80303 were analyzed and potential predictive biomarkers for B were identified. This follow-up analysis evaluated citrated plasma samples for circulating proteins related to matrix remodeling and coagulation. Methods: Multiplex ELISA analysis was employed to assess the following circulating factors: E-selectin, matrix metalloprotease (MMP) 2, MMP9, von Willebrand factor (vWF), D-dimer, thrombospondin 1, and tissue factor (TF). Thrombin-antithrombin complex (TAT) was analyzed using a standard enzyme immunoassay. Prognostic characteristics were determined by associating baseline values with OS using a Cox model. Predictive markers were identified with inclusion of a treatment by marker interaction term. Results: Baseline citrated plasma samples from 109 pts were included in this analysis (59 pts G+P; 50 pts G+B). Negative prognostic factors for OS were identified, including E-selectin (p <0.01) for patients receiving G-based therapy, and E-selectin, TF, and vWF (p <0.05) in pts receiving G+P. Potential biomarkers predicting for OS benefit from B were also identified. Pts with low (< median) levels of TAT (interaction p=0.034) exhibited a median OS of 6.0 months (mo) vs. 8.3 mo (HR=0.49; 95%CI 0.28-0.88) when receiving G+P vs. G+B, respectively. Furthermore, pts with elevated levels of TF (>Q3) were found to benefit from B (interaction p=0.021), with median OS of 4.3 mo vs 4.8 mo (HR=0.44;95%CI 0.18-1.08), respectively. Longitudinal analysis of samples collected at baseline and at cycle 3 indicated that only vWF changed in pts receiving G+P, with an increase in vWF (p<0.05). Conclusions: In patients with APC, baseline levels of TAT and TF were identified as potential predictors of benefit from B. These data emphasize the importance of coagulation factors in modulating tumor angiogenesis. The potential predictive value of these factors warrants further validation.

scholarly journals Validation of the Relationship Between Coagulopathy and Localization of Hydroxyethyl Starch on the Vascular Endothelium in a Rat Hemodilution Model

2021 ◽  
Author(s):  
Ryu Azumaguchi ◽  
Yasuyuki Tokinaga ◽  
Satoshi Kazuma ◽  
Motonobu Kimizuka ◽  
Kosuke Hamada ◽  
...  
Keyword(s):  
Hydroxyethyl Starch ◽  
Von Willebrand Factor ◽  
Shear Viscosity ◽  
Formation Rate ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
High Shear ◽  
Membrane Glycoproteins ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract BackgroundVarious anticoagulant properties have been associated with hydroxyethyl starch (HES), including coagulation disorders measured by point-of-care devices, decreases in von Willebrand factor and coagulation factor VIII, and inhibition of the interactions between platelet-membrane glycoproteins and of coagulation factors by coating of platelets. However, the mechanism for these properties remains unclear. The aim of this study was to test the hypothesis that coagulopathy induced by HES is caused by endothelial or glycocalyx damage as a result of localization of HES on the endothelium, due to the high shear viscosity of blood, using a rat model.MethodsWe compared blood coagulability measured by Sonoclot®, levels of endothelial and glycocalyx damage markers and coagulation factors, and blood shear viscosity when hemodilution was performed with physiological saline (PS), 6% HES 130/0.4 in PS (HES130) and 10% HES 200/0.5 in PS (HES200). To precisely evaluate the basic mechanism of coagulopathy induced by HES, we performed hemodilution with an emphasis on dilutional equality by taking into consideration the intravascular residual rates of the infusion preparations. We also evaluated the localization rates of fluorescently labeled HES on endothelium in the isolated aorta. Statistical analyses were performed by one-way ANOVA followed by Tukey’s test or Kruskal–Wallis test, and then Dunn’s test for multiple comparisons.ResultsSonoclot® measurements revealed that HES130 and HES200 decreased the fibrin gel formation rate to a greater extent than PS, and HES200 decreased the rate more than HES130. Similarly, HES130 and HES200 decreased von Willebrand factor levels to a greater extent than PS. HES130 and HES200 had a more protective effect than PS, with no evidence of damage to the endothelium or glycocalyx. Shear viscosity was variable between all pairs, and was lowest for PS and highest for HES200. HES130 and HES200 demonstrated comparable degrees of localization on the endothelium.ConclusionsHES was shown to cover the endothelium, possibly due to its high shear viscosity, and this mechanism potentially acted to protect the endothelium and glycocalyx. However, this covering effect may be the cause of coagulopathy due to inhibition of von Willebrand factor secretion from the endothelium.

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