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Chapter: Paediatrics: Haematology

Paediatrics: Coagulation studies

APTT: principally assesses the ‘intrinsic’ path of the coagulation cascade.

Coagulation studies

 

See Table 17.3


·  APTT: principally assesses the ‘intrinsic’ path of the coagulation cascade.

 

·  PT or INR (monitoring warfarin therapy): assesses ‘extrinsic’ pathway.

 

·  Thrombin time (TT): only used to differentiate between heparin contamination, dysfibrinogenaemia and DIC. This test is not used routinely and needs to be requested specifically.

 

·  Serum fibrinogen: useful if DIC or haemophagocytic lymphohistiocytosis (HLH) is suspected.

 

·  PFA: In vitro test of platelet function. This test is easy to perform provided the platelet count >100 × 109/L. Ranges in children have been produced.

 

·  Bleeding time: tests platelet function. Now virtually obsolete.

 

·  Fibrin degradation products (FDPs): Components released into the blood following clot degradation. Levels rise after any thrombotic event. Can be used to test for DIC. The most notable subtype of FDPs is D-dimer.

 

·  D-dimer: principally used to screen adults for thrombotic disorders, e.g. deep vein thrombosis (DVT). Rarely used in children except possibly to help monitor management of DIC (possibly along with FDPs). Note: DIC is a clinical diagnosis and is not made my measuring D-dimers or FDPs.

 

Other specific tests include screening tests of coagulation inhibitor, e.g. lupus anticoagulant, or individual clotting factor level


 

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