VPB0284 - The potentiality of thromboelastographic examination of newborns with venous thrombosis

Background: An extended hemostasiological examination in newborns with thrombosis allows operatively detect an increased coagulation potential.

Aims: To determine main indicators of an extended hemostasiological examination for early thrombotic events detection in newborns.

Methods: The research group includes newborns (30) with thrombotic risk factors (hemostasis system genetic polymorphisms, intrauterine hypoxia and infection) and realized venous thrombosis. The main diagnostic methods were: anamnestic, clinical, laboratory and instrumental examinations (ultrasound to visualize blood clots and signs of perinatal hypoxia, PCR-tests to detect hemostasis system genes polymorphisms and infections, thromboelastographic analyse and comparative platelet-rich plasma [PRP] and platelet-poor plasma [PPP] tests, and aggregation and functional platelets activity determining methods.

Results: All patients have thrombotic and aggravated obstetric anamnesis. All patients were born with hypoxic-ischemic brain injury and realized intrauterine infection (congenital pneumonia). Every third child (27.2%) was born prematurely. Ultrasound visualized thrombosis in ramus sinister venae portae in all cases. Neurosonographic examination determined hypoxic-ischemic brain injury entire research group. Among the research group most frequently detected hemostasiс system genetic polymorphisms were homozygous variant PAI-1 (nucleotide substitution c.-820_-820insG, 80.0%), heterozygous variant MTHFR (c.665C>T, 60%), heterozygous MTRR variant (c.66A>G, 50.0%). Identified infection thrombogenic risk factors were: Klebsiella pneumoniae (20.0%), Staphylococcus haemolyticus (26.6%), Escherichia coli (20.0%) (PCR-test). During a hemostasiological examination in children with thrombosis were noted: chronometric hypercoagulation (70.0%), an increase in the ∠α (76.6%), a decrease in the functional and aggregation activity of platelets (76.6%, respectively) and an increase in their coagulant activity at the same time (76.6%).

Conclusion(s): The main extended hemostasiological examination indicators, indicating coagulopathy, strong hypercoagulability and a high thrombosis risk in newborns, are: chronometric hypercoagulation, an increase of the ∠α, a decrease of functional and aggregation platelets activity, and an increase of coagulant platelets activity.