BACKGROUND Phlebotomy is among the main determinants of anemia of prematurity. Blood sparing policies endorsed umbilical cord blood (here called placental) as an alternative source for laboratory testing. Little is known on the suitability of placental blood to evaluate neonatal hemostasis of newborn infants. We aimed to compare the hemostatic profile of paired placental and infant venous blood, by means of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, protein C, thromboelastography (TEG) and thrombin generation assay (TGA). STUDY DESIGN This was an observational single-center study. METHODS We collected at birth venous citrated blood from both placental and infant venous source and performed PT, APTT, fibrinogen, antithrombin, protein C, TEG (reaction time-R; kinetics-K alpha angle-alpha, maximum amplitude-MA and lysis at 30 minutes-LY30), and TGA (endogenous thrombin potential-ETP). RESULTS We enrolled 60 neonates with a median gestational age (range) of 37 weeks (28(+1)-41) and birth-weight 2417 g (950-4170). Based on TEG and TGA, placental blood showed a procoagulant imbalance as indicated by lower median R (4.0 vs. 6.1 min; p < 0.001) and K (1.3 vs. 2.2 min; p < 0.001); higher alpha-angle (69.7 vs. 57.4 degrees; p < 0.001) and ETP (1260 vs. 1078; p = 0.002) than those observed for infant venous blood. PT and APTT did not differ significantly between the two groups. CONCLUSIONS While placental and neonatal blood samples are equally suitable to measure the standard coagulation tests PT and APTT, placental blood leads to a procoagulant imbalance when testing is performed with TEG or TGA. These effects should be considered when interpreting results stemming from investigation of neonatal hemostasis.

Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth? / G. Raffaeli, A. Tripodi, F. Manzoni, E. Scalambrino, N. Pesenti, I. Amodeo, G. Cavallaro, E. Villamor, F. Peyvandi, F. Mosca, S. Ghirardello. - In: TRANSFUSION. - ISSN 0041-1132. - 60:5(2020 May 01), pp. 1069-1077. [10.1111/trf.15785]

Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth?

G. Raffaeli
Primo
;
A. Tripodi
Secondo
;
F. Manzoni;E. Scalambrino;I. Amodeo;F. Peyvandi;F. Mosca;
2020-05-01

Abstract

BACKGROUND Phlebotomy is among the main determinants of anemia of prematurity. Blood sparing policies endorsed umbilical cord blood (here called placental) as an alternative source for laboratory testing. Little is known on the suitability of placental blood to evaluate neonatal hemostasis of newborn infants. We aimed to compare the hemostatic profile of paired placental and infant venous blood, by means of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, protein C, thromboelastography (TEG) and thrombin generation assay (TGA). STUDY DESIGN This was an observational single-center study. METHODS We collected at birth venous citrated blood from both placental and infant venous source and performed PT, APTT, fibrinogen, antithrombin, protein C, TEG (reaction time-R; kinetics-K alpha angle-alpha, maximum amplitude-MA and lysis at 30 minutes-LY30), and TGA (endogenous thrombin potential-ETP). RESULTS We enrolled 60 neonates with a median gestational age (range) of 37 weeks (28(+1)-41) and birth-weight 2417 g (950-4170). Based on TEG and TGA, placental blood showed a procoagulant imbalance as indicated by lower median R (4.0 vs. 6.1 min; p < 0.001) and K (1.3 vs. 2.2 min; p < 0.001); higher alpha-angle (69.7 vs. 57.4 degrees; p < 0.001) and ETP (1260 vs. 1078; p = 0.002) than those observed for infant venous blood. PT and APTT did not differ significantly between the two groups. CONCLUSIONS While placental and neonatal blood samples are equally suitable to measure the standard coagulation tests PT and APTT, placental blood leads to a procoagulant imbalance when testing is performed with TEG or TGA. These effects should be considered when interpreting results stemming from investigation of neonatal hemostasis.
Settore MED/38 - Pediatria Generale e Specialistica
21-apr-2020
Article (author)
File in questo prodotto:
File Dimensione Formato  
MS_Hemostasis placenta_transfusion[1].pdf

accesso aperto

Tipologia: Pre-print (manoscritto inviato all'editore)
Dimensione 199.02 kB
Formato Adobe PDF
199.02 kB Adobe PDF Visualizza/Apri
trf.15785.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 429.81 kB
Formato Adobe PDF
429.81 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/731586
Citazioni
  • ???jsp.display-item.citation.pmc??? 4
  • Scopus 6
  • ???jsp.display-item.citation.isi??? 6
social impact