BMSEHA15
Published online 9 April 2008
Haematologica, Vol 93, Issue 8, 1256-1259 doi:10.3324/haematol.12566
Copyright © 2008 by Ferrata Storti Foundation
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Disorders of Hemostasis

Normal thrombin generation in neonates in spite of prolonged conventional coagulation tests

Armando Tripodi1, Luca A. Ramenghi2, Veena Chantarangkul1, Agnese De Carli2, Marigrazia Clerici1, Michela Groppo2, Fabio Mosca2, Pier Mannuccio Mannucci1

1 Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine
2 NICU, Institute of Pediatrics and Neonatology, University and IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milano, Italy

Correspondence: Pier Mannuccio Mannucci, via Pace 9, 20122 Milan, Italy. E-mail:piermannuccio.mannucci{at}unimi.it

Conventional coagulation tests might be inadequate to explore mechanisms regulating thrombin generation in neonates, because they do not allow full activation of the reduced levels of protein C. Therefore, they do not reflect the action of pro- and anti-coagulants as does the endogenous thrombin potential assessed in the presence of thrombomodulin. Endogenous thrombin potential measured without thrombomodulin was greater than the lower-limit of the adult reference interval in 30% of 109 full-term and 49% of 55 pre-term neonates, a finding consistent with the reduced levels of procoagulants in this setting. When the test was modified adding thrombomodulin, endogenous thrombin potential reverted into the adult reference interval in 97% and 100% full-term and pre-term neonates. In conclusion, the coagulation balance in neonates is restored by the concomitant reduction of pro- and anticoagulants. The restored balance can be shown in vitro by the endogenous thrombin potential test that includes thrombomodulin, but not by conventional coagulation tests.

Key words: newborns, coagulation balance, procoagulant factors, anticoagulant factors, activated partial thromboplastin.