ICS-Heme-Pediatric: Hemostasis & D/O in Newborn
Terms
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- Inhibitors of Coagulation--inc/dec/nl at birth??
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1. Direct Inhibitors (C1 esterase inh, alpha-2 macroglobulin): INC at birth
2. Protein C/S = VIT K DEPENDENT
-Thrombomodulin INC at birth until early childhood
-Protein C and S DEC at birth
3. Tissue Factor Pathway Inhibitor (TFPI) binds and inactivates Factor 7a-->prevents further generation of thrombin - Fibrinolytic System: inc or dec at birth?
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1.t-PA and PAI are INC in newborn but DEC in cord blood at birth
2.alpha-2-antiplasmin (80% of adult level)
3.Plasminogen (50% of adult level) - MCC causes of bleeding in healthy infants
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1.imm-mediated thrombocytopenia
2.vit K def
3.congenital factor def - MC hemostatis abnormality in newbortns
- thrombocytopenia
- et of thrombocytopenia
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1.Inc destruction of platelets
2.Dec prod
3.hypersplenism (sequester platelets in spleen) - how Tx bleeding infant
- platelet transfusion 10-20 ml/kg (regardless of cause of bleed in the infant!)
- Acquired Hemostatic D/O in newborn
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1.DIC
2.Liver Dz
3.Vit K def - how Dx DIC in newborn
- dec Factor 5, 8, and fibrinogen (NOT ATIII/thrombin)
- how Dx DIC in neonates
- can't
- DECREASED prothrombin activity and INC PT on day 2 to 4 of life with return to normal by days 5 to 7 indicates
- Vit K def (need Vit K for Factors 2 (prothrombin), 7, 9, and 10)
- VK1 is called what and found where?
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phytonadione;
found in green leafy veggies - VK2 is called what and found where?
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metaquinanone;
prod by intestinal flora - VK3 is called what and found where?
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menadione;
synthetic, water-soluble - how prevent decrease in prothrombin activiy during first 3-4 days of life
- administer Vit K