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Alhaj D, Hagedorn N, Cuntz F, Reschke M, Schuldes J, Ruthenberg J, Bakchoul T, Greinacher A, Holzhauer S. ISTH bleeding assessment tool and platelet function analyzer in children with mild inherited platelet function disorders. Eur J Haematol 2024; 113:54-65. [PMID: 38549165 DOI: 10.1111/ejh.14198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES To evaluate the diagnostic performance of platelet function analyzer (PFA) and The International Society on Thrombosis and Hemostasis bleeding-assessment-tool (ISTH-BAT) in detecting mild inherited platelet function disorders (IPFDs) in children with suspected bleeding disorders. METHODS Prospective single-center diagnostic study including consecutive patients <18 years with suspected bleeding disorder and performing a standardized workup for platelet function defects including ISTH-BAT, PFA, platelet aggregation testing, blood smear-based immunofluorescence, and next-generation sequencing-based genetic screening for IPFDs. RESULTS We studied 97 patients, of which 34 von Willebrand disease (VWD, 22 type-1, 11 type-2), 29 IPFDs (including delta-/alpha-storage pool disease, Glanzmann thrombasthenia, Hermansky-Pudlak syndrome) and 34 with no diagnosis. In a model combining PFA-adenosine diphosphate (ADP), PFA-epinephrine (EPI), and ISTH-BAT overall performance to diagnose IPFDs was low with area under the curves of 0.56 (95% CI 0.44, 0.69) compared with 0.84 (95% CI 0.76, 0.92) for VWD. Correlation of PFA-EPI/-ADP and ISTH-BAT was low with 0.25/0.39 Spearman's correlation coefficients. PFA were significantly prolonged in patients with VWD and Glanzmann thrombasthenia. ISTH-BAT-scores were only positive in severe bleeding disorders, but not in children with mild IPFDs or VWD. CONCLUSION Neither ISTH-BAT nor PFA or the combination of both help diagnosing mild IPFDs in children. PFA is suited to exclude severe IPFDs or VWD and is in this regard superior to ISTH-BAT in children.
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Affiliation(s)
- Dana Alhaj
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Nikola Hagedorn
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Franziska Cuntz
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Madlen Reschke
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Joerg Schuldes
- Department of Human Genetics, Labor Berlin, Berlin, Germany
| | - Juliane Ruthenberg
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Tamam Bakchoul
- Institute for Clinical and Experimental Transfusion Medicine, Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Andreas Greinacher
- Institute for Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
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Affiliation(s)
- Alice W Newton
- From the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Massachusetts General Hospital, and the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Harvard Medical School - both in Boston
| | - Paul A Caruso
- From the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Massachusetts General Hospital, and the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Harvard Medical School - both in Boston
| | - David H Ebb
- From the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Massachusetts General Hospital, and the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Harvard Medical School - both in Boston
| | - Grace Linder
- From the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Massachusetts General Hospital, and the Departments of Pediatrics (A.W.N., D.H.E.), Radiology (P.A.C.), and Pathology (G.L.), Harvard Medical School - both in Boston
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Collins PW, Hamilton M, Dunstan FD, Maguire S, Nuttall DE, Liesner R, Thomas AE, Hanley J, Chalmers E, Blanchette V, Kemp AM. Patterns of bruising in preschool children with inherited bleeding disorders: a longitudinal study. Arch Dis Child 2017; 102:1110-1117. [PMID: 27449675 PMCID: PMC5754865 DOI: 10.1136/archdischild-2015-310196] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The extent that inherited bleeding disorders affect; number, size and location of bruises in young children <6 years. DESIGN Prospective, longitudinal, observational study. SETTING Community. PATIENTS 105 children with bleeding disorders, were compared with 328 without a bleeding disorder and classified by mobility: premobile (non-rolling/rolling over/sitting), early mobile (crawling/cruising) and walking and by disease severity: severe bleeding disorder factor VIII/IX/XI <1 IU/dL or type 3 von Willebrand disease. INTERVENTIONS Number, size and location of bruises recorded in each child weekly for up to 12 weeks. OUTCOMES The interventions were compared between children with severe and mild/moderate bleeding disorders and those without bleeding disorders. Multiple collections for individual children were analysed by multilevel modelling. RESULTS Children with bleeding disorders had more and larger bruises, especially when premobile. Compared with premobile children without a bleeding disorder; the modelled ratio of means (95% CI) for number of bruises/collection was 31.82 (8.39 to 65.42) for severe bleeding disorders and 5.15 (1.23 to 11.17) for mild/moderate, and was 1.81 (1.13 to 2.23) for size of bruises. Children with bleeding disorders rarely had bruises on the ears, neck, cheeks, eyes or genitalia. CONCLUSIONS Children with bleeding disorder have more and larger bruises at all developmental stages. The differences were greatest in premobile children. In this age group for children with unexplained bruising, it is essential that coagulation studies are done early to avoid the erroneous diagnosis of physical abuse when the child actually has a serious bleeding disorder, however a blood test compatible with a mild/moderate bleeding disorder cannot be assumed to be the cause of bruising.
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Affiliation(s)
- Peter W Collins
- Department of Haematology, Institute of Infection and Immunity, School of Medicine Cardiff University, Cardiff, UK
| | | | - Frank D Dunstan
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
| | - Sabine Maguire
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
| | - Diane E Nuttall
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
| | - Ri Liesner
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Angela E Thomas
- Department of Haematology, Royal Hospital for Sick Children, Edinburgh, UK
| | - John Hanley
- Department of Haematology, Royal Victoria Infirmary, Newcastle, UK
| | - Elizabeth Chalmers
- Department of Haematology, Royal Hospital for Sick Children, Glasgow, UK
| | - Victor Blanchette
- Department of Paediatrics, University of Toronto, Toronto, Canada,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Alison M Kemp
- Institute of Primary Care and Public Health, School of Medicine Cardiff University, UK
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Paroskie A, Carpenter SL, Lowen DE, Anderst J, DeBaun MR, Sidonio RF. A two-center retrospective review of the hematologic evaluation and laboratory abnormalities in suspected victims of non-accidental injury. CHILD ABUSE & NEGLECT 2014; 38:1794-800. [PMID: 24928052 PMCID: PMC4427034 DOI: 10.1016/j.chiabu.2014.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 06/03/2023]
Abstract
Investigation for bleeding disorders in the context of suspected non-accidental injury (NAI) is inconsistent. We reviewed the hematologic evaluation of children who presented with symptoms of bleeding and/or bruising suspicious for NAI to determine the frequency of hematologic tests, abnormal hematologic laboratory results, and hematologic diagnoses. A retrospective cohort study design was employed at two freestanding academic children's hospitals. ICD-9 codes for NAI were used to identify 427 evaluable patients. Medical records were queried for the details of clinical and laboratory evaluations at the initial presentation concerning for NAI. The median age for the population was 326 days (range 1 day-14 years), 58% were male. Primary bleeding symptoms included intracranial hemorrhage (31.8%) and bruising (68.2%). Hematologic laboratory tests performed included complete blood cell count in 62.3%, prothrombin time (PT) in 55.0%, and activated partial thromboplastin time (aPTT) in 53.6%; fibrinogen in 27.6%; factor activity in 17.1%; von Willebrand disease evaluation in 14.5%; and platelet function analyzer in 11.7%. Prolonged laboratory values were seen in 22.5% of PT and 17.4% of aPTT assays; 66.0% of abnormal PTs and 87.5% of abnormal aPTTs were repeated. In our cohort, 0.7% (3 of 427) of the population was diagnosed with a condition predisposing to bleeding. In children with bleeding symptoms concerning for NAI, hemostatic evaluation is inconsistent. Abnormal tests are not routinely repeated, and investigation for the most common bleeding disorder, von Willebrand disease, is rare. Further research into the extent and appropriate timing of the evaluation is warranted.
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Affiliation(s)
| | | | - Deborah E Lowen
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - James Anderst
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Michael R DeBaun
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Robert F Sidonio
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Utility of a child abuse screening guideline in an urban pediatric emergency department. J Trauma Acute Care Surg 2014; 76:871-7. [PMID: 24553563 DOI: 10.1097/ta.0000000000000135] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have found racial and socioeconomic status bias in the way clinicians screen for and detect child abuse in patients presenting to the emergency department. We hypothesized that implementing a guideline for screening would attenuate this bias. METHODS An algorithm for child abuse screening in patients younger than 1 year presenting with fractures was developed for a pediatric trauma center emergency department. Data were collected 1.5 years before and after implementation of the algorithm to investigate implementation success. Data were compared before and after the implementation of the algorithm using χ and univariate logistic regression analysis. RESULTS The characteristics of patients with fractures were similar before and after the algorithm implementation. Implementation of the algorithm was related to a significant increase in algorithm required screenings: skeletal survey (p < 0.001), urinalysis (p < 0.001), and transaminase levels (p < 0.001). The racial composition of those screened did not change after the implementation of the protocol. Children with government-subsidized or no insurance were more likely to be screened for child abuse via skeletal survey before the algorithm implementation compared with those with private insurance (odds ratio, 2.7; 95% confidence interval, 1.2-6.0; p = 0.017). This relationship did not exist after the algorithm implementation (odds ratio, 1.2; 95% confidence interval, 0.56-2.46; p = 0.66). Final determination of child abuse was related to insurance status both before and after the algorithm implementation. CONCLUSION A child abuse screening algorithm was successfully implemented in an urban trauma center. After implementation, screening was no longer associated with socioeconomic status of the patient's family, although final determination of child abuse still was. Additional research is needed to determine utility of unbiased screening on patient outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.
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6
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The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.8.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Michelle GKW, Amy O, Anne N, C Louise M. L’évaluation médicale des ecchymoses dans les cas de maltraitance présumée d’enfants : une perspective clinique. Paediatr Child Health 2013. [DOI: 10.1093/pch/18.8.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Jackson J, Carpenter S, Anderst J. Challenges in the evaluation for possible abuse: presentations of congenital bleeding disorders in childhood. CHILD ABUSE & NEGLECT 2012; 36:127-134. [PMID: 22398301 DOI: 10.1016/j.chiabu.2011.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/26/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To describe children with congenital bleeding disorders that present in a manner that may be concerning for non-accidental trauma (NAT), and to evaluate associations with disease and demographic characteristics. METHODS Ten year retrospective chart review of subjects at a Hemophilia Treatment Center. Demographic, historical, and disease characteristics were collected. Findings were compared to a priori criteria for bleeding/bruising that is concerning for abuse. RESULTS Twenty-nine (15.3%) of the 189 children in the study had an initial presentation that was concerning for NAT. Of those 29, 75.9% were <5 years of age, 44.8% had von Willebrand disease (vWD), 51.8% had hemophilia, and 48.3% had a family history of a named bleeding disorder. Children from 9 months through 5 years of age were more likely than older children to present with findings concerning for abuse (OR 3.32, 1.21-9.10). No association was detected between presentation concerning for abuse and gender (OR 1.51, 0.6-3.77). Hemophilia was no more likely than vWD to present in a manner that was concerning for abuse (OR 0.7, 0.31-1.58). No children presented with patterned bruising. CONCLUSIONS Children with bleeding disorders may present with bruising/bleeding that is clinically highly suggestive of NAT. PRACTICE IMPLICATIONS Infants and young mobile children who have non-patterned bruising or bleeding as the only symptom concerning for abuse require an evaluation that includes testing for hemophilia and vWD. Children who have laboratory testing that indicates the presence of a bleeding disorder, but have clinical findings concerning for abuse, may benefit from a collaborative evaluation including a pediatric hematologist and a child abuse pediatrician.
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Affiliation(s)
- Jami Jackson
- Children's Mercy Hospital, Department of Emergency Medicine, Kansas City, MO, USA
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10
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Barnes PD. Imaging of nonaccidental injury and the mimics: issues and controversies in the era of evidence-based medicine. Radiol Clin North Am 2011; 49:205-29. [PMID: 21111136 DOI: 10.1016/j.rcl.2010.08.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Because of the controversy involving the determination of child abuse, or nonaccidental injury (NAI), radiologists must be familiar with the issues, literature, and principles of evidence-based medicine to understand the role of imaging. Children with suspected NAI must receive protective evaluation along with a timely and complete clinical and imaging work-up. Imaging findings cannot stand alone and must be correlated with clinical findings, laboratory testing, and pathologic and forensic examinations. Only the child protection investigation may provide the basis for inflicted injury in the context of supportive clinical, imaging, biomechanical, or pathology findings.
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Affiliation(s)
- Patrick D Barnes
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University Medical Center, 725 Welch Road, Palo Alto, CA 94304, USA.
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11
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Singleton T, Kruse-Jarres R, Leissinger C. Emergency Department Care for Patients with Hemophilia and Von Willebrand Disease. J Emerg Med 2010; 39:158-65. [DOI: 10.1016/j.jemermed.2007.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 12/14/2007] [Accepted: 12/23/2007] [Indexed: 11/15/2022]
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12
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Abstract
Three premobile infants with unexplained bruising are described. Although, they were asymptomatic otherwise, evaluation led to the recognition of inflicted rib fractures in two and hemophilia A in one. Although such bruises are inconsequential themselves, they may provide the opportunity to recognize serious problems before major injury or morbidity occurs.
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Bolton-Maggs PHB, Chalmers EA, Collins PW, Harrison P, Kitchen S, Liesner RJ, Minford A, Mumford AD, Parapia LA, Perry DJ, Watson SP, Wilde JT, Williams MD. A review of inherited platelet disorders with guidelines for their management on behalf of the UKHCDO. Br J Haematol 2006; 135:603-33. [PMID: 17107346 DOI: 10.1111/j.1365-2141.2006.06343.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The inherited platelet disorders are an uncommon cause of symptomatic bleeding. They may be difficult to diagnose (and are likely to be under-diagnosed) and pose problems in management. This review discusses the inherited platelet disorders summarising the current state of the art with respect to investigation and diagnosis and suggests how to manage bleeding manifestations with particular attention to surgical interventions and the management of pregnancy.
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Lee ACW, Li CH, So KT. The impact of a management protocol on the outcomes of child abuse in hospitalized children in Hong Kong. CHILD ABUSE & NEGLECT 2006; 30:909-17. [PMID: 16930698 DOI: 10.1016/j.chiabu.2006.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 02/03/2006] [Accepted: 03/02/2006] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To study the outcomes of children hospitalized for suspected child abuse before and after the implementation of a management protocol in a hospital in Hong Kong. STUDY PERIOD Two 2-year periods before (1994-1995) and after (2002-2003) the implementation of the protocol in 1998. METHODS This is a retrospective hospital chart review in which the patients' characteristics, the use of laboratory and radiological examination, abuse substantiation and official registrations are compared between the two study periods. RESULTS There were 109 and 320 patients admitted for evaluation of child abuse for the periods 1994-1995 and 2002-2003, respectively. Children in both periods were similar in sex ratio, proportion of severe forms of child abuse, rates of abuse substantiation and inclusion in the Child Protection Registry. After the implementation of a management protocol, there has been a significant drop in the proportion of children subjected to investigations such as blood counts (86% vs. 16%, p<.001), clotting study (75% vs. 9%, p<.001), and skeletal survey (78% vs. 6%, p<.001). The average length of hospital stay also dropped from 15.3 days to 6.1 days (p<.001). CONCLUSIONS There has been an almost threefold rise in the number of child abuse cases handled at the hospital during the 10-year interval. With the implementation of a management protocol, only a small proportion of children need laboratory investigations or skeletal survey without any drop in abuse substantiation and official registration. The length of hospital stay has also been significantly reduced.
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Affiliation(s)
- Anselm C W Lee
- Department of Paediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China
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Inagaki M, Mori T, Tsunematsu Y, Ambo H, Kawai Y. Use of recombinant activated factor VII to control bleeding in a young child with qualitative platelet disorder: a case report. Blood Coagul Fibrinolysis 2006; 17:317-22. [PMID: 16651876 DOI: 10.1097/01.mbc.0000224853.50248.6f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Defects of platelet adhesion, aggregation, secretion, or procoagulant activities can lead to bleeding diathesis of variable severity. We used recombinant activated factor VII (rFVIIa) in the treatment of uncontrolled epistaxis in a patient with a qualitative platelet disorder. We aimed to assess the efficacy of a single rFVIIa dose (100 microg/kg) in the control of mild and severe refractory epistaxis, and evaluate the influence of rFVIIa on markers of platelet adhesion and aggregation during a period of hematological stability (i.e. non-bleeding, no medication). The efficacy study showed mild episodes of epistaxis could be successfully managed using a single rFVIIa (100 microg/kg) dose; however, severe bleedings were not well controlled, and platelet transfusion was required to achieve hemostasis. Hematological investigations showed ADP-induced and collagen-induced platelet aggregation increases from 20 to 34% and 16 to 30%, respectively, following rFVIIa administration. There were no differences between pre-dose and post-dose concentrations of membrane glycoproteins. rFVIIa may therefore induce platelet aggregation by activating a glycoprotein-independent aggregation pathway. rFVIIa may have a role in managing mild bleeding episodes not controlled using conventional measures in patients with a qualitative platelet disorder. Further research is needed to determine the mechanism of action, efficacy, and safety of rFVIIa in this population.
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Abstract
Bruising and bleeding are commonly seen in children and are usually associated with minor injury and trauma. However, in two groups of children the bruising may be more significant than expected: those with an underlying haemostatic abnormality, such as an inherited bleeding disorder, or those who have been subjected to non-accidental injury (NAI). Diagnosing inherited bleeding disorders in children is fraught with difficulty, from venous access to interpretation of results; the possibility of NAI should be borne in mind, even in those children with proven significant bleeding disorders when the severity of the injury and the history are non-compatible. We describe the investigation of the haemostatic system in children with bruising and/or bleeding with emphasis on the key haemostatic disorders that need to be excluded.
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Affiliation(s)
- Kate Khair
- Haemophilia Comprehensive Care Centre, Great Ormond St NHS Trust, London, UK.
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Abstract
Physicians often see patients who complain of "easy bruising." The skill of the clinician is to identify those patients likely to have a potentially serious underlying disorder from those who do not. A detailed history often provides sufficient information. A comprehensive physical examination and possibly some baseline laboratory studies can add more data. These tools should permit the clinician to decide if the patient is either basically normal, may have simple contributing factors that lead to bruising, or is at significant risk of bleeding due to the presence of an underlying disorder. In certain circumstances, the situation will prompt the referral to a hematologist or other specialist (gastroenterologist, nephrologist, rheumatologist, endocrinologist, etc.).
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Affiliation(s)
- Maria J Valente
- Division of Hematology/Oncology, Mayo Clinic, and the Division of Education and Research, Baptist Cancer Institute, Jacksonville, FL, USA
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Harrison P. The role of PFA-100R testing in the investigation and management of haemostatic defects in children and adults. Br J Haematol 2005; 130:3-10. [PMID: 15982339 DOI: 10.1111/j.1365-2141.2005.05511.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The PFA-100 provides a simple global measure of high shear-dependent platelet function, and as such is not diagnostic or specific to any disorder. Prolonged closure times must be interpreted in conjunction with a full blood count, von Willebrand factor (VWF) screen and other platelet tests. The PFA-100 may also give false negative results with relatively common platelet defects. If clinical suspicion is high, further detailed platelet function testing and VWF screening are required to exclude abnormal platelet function, even if the PFA-100 is normal. In more recent studies the PFA-100 has been used for preoperative identification and management of surgical patients with haemostatic defects and for assessing the clinical effectiveness of platelet transfusion therapy. This review highlights the up to date, evidence-based, advantages and disadvantages of the PFA-100 test in the investigation and management of haemostatic disorders in both children and adults.
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Affiliation(s)
- Paul Harrison
- Oxford Haemophilia Centre and Thrombosis Unit, Churchill Hospital, Headington, Oxford, UK.
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