Antithrombin III Levels in Asphyxiated Newborns and Relation to Disseminated Intravascular Coagulation
Abstract
While
many asphyxiated newborn are admitted to the hospital with bleeding problems,
disseminated intravascular coagulation (DIC) develops in some cases during
follow-up. Although it is known that the basic principle in the treatment of
DIC is to correct the underlying problem, diagnosis in pre-DIC is the most
important factor in the success of treatment. Various studies and animal
experiments show that there are some changes in coagulation factors before DIC
develops. One of these changes is the reduction of antithrombin III (AT III)
levels. The aim of this study was to investigate the association of AT III
levels with DIC in asphyxiated infants. Fifty infants exposed to various
degrees of asphyxia in the first hours following birth and 20 healthy infants
born without complications were included in the study. In both groups, AT III,
PT, PTT, D dimer levels and platelet counts were studied during the first 12
hours after birth. Early AT III values of developing and non-developing
infants with DIC were compared and the value of AT III early diagnosis of DIC
was investigated. Asphyxiated infants had lower levels of AT III and platelet
counts and significantly higher PT, PTT and D dimer levels than control group. The
initial AT III levels (14.01 ± 5.11) of the infants with DIC were significantly
lower than those without DIC (19.03 ± 2.74) (P <0.05). The D dimer height
ratio was 100% in the developing group, 55% in the non-developing group, and the
difference was significant. No significant difference was found between PT, PTT
and platelet counts of two groups. As a result; the AT III levels in
asphyxiated infants are lower than in healthy infants and the AT III level
determination in asphyxiated infants with DIK suspicion may be indicative of
the pre-DIC status together with D dimer levels.
Keywords
References
- 1. Bona E, Hagberg H, Loberg EM, et al. Protective effects of moderate hypothermia after neonatal hypoxia-ischemia: short- and long-termoutcome. Pediatr Res. 1998; 43: 738–745.
- 2. Oncel MY, Erdeve O, Calisici E, et al. The effect of whole-body cooling on hematological and coagulation parameters in asphyxic newborns. Pediatr Hematol Oncol. 2013; 30: 246-52.
- 3. Vanucci RC. Hypoxic ischemic encephalopathy. Am J Perinatol. 2000;17: 113–120.
- 4. Küçüködük Ş. Yenidoğan ve Hastalıkları (1. Baskı). Feryal matbaası, Ankara 1994, ss 341- 381.
- 5. Phelan JP, Kirkendall C, KorstLM, MartinGI. Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment. J Matern Fetal Neonatal Med 2007; 20: 377-80.
- 6. Pugh M, Catherine L. DIC Screening in the Newborn. Neonatal Network 1997; 16: 57- 60.
- 7. Choudhry VP, Thavaraj V, Saraya AK. Disseminated Intra Vascular Coagulation: Diagnosis and Current Therapy. Indian Pediatrics 1990; 27: 280-288.
- 8. Mammen EF, Farag AA. The Role of Antithrombin III in DIC. Biologia&Clinica Hematologica 1987;9: 69-73.
- 9. Bick RL, Dukes ML, Wilson WL, Fekete LF. Antithrombin III ( AT-III) as a Diagnostic Aid in Disseminated Intravascular Coagulation. Thromb Res 1977;10: 721-729.
- 10. Bick RL. Clinical Relevance of Antithrombin III. Sem Thromb Hemost 1982;8: 276-285.
- 11. Peters M, Janseb E, Ten Cate JW, et al. Neonatal Antithrombin III. British J Haematol 1984;58: 579-287.
- 12. Fichera A, Pratico G, Sciacca F. Neonatal Hypoxia and Hemocoagulative Changes. Pediatr Med Chir 1989;11: 643-647.
- 13. Chadd MA, Elwood PC, Gray OP, Muxworthy SM. Coagulation Defects in Hypoxic Full- term Newborn Infants. Britsh Medical Journal 1971;4: 516- 518.
- 14. Schander K, Rehm A, Niesen M. Blood Coagulation Activity and Fibrinolysis in Umbilical Vein Blood of Healthy and Asphyxiated Newborn Infants. Fortschr Med 1977; 95: 1477- 1481.
- 15. McDonald TP, Cottrell M, Clift R. Effect of Short- Term Hypoxia on Platelet Counts of Mice. Blood 1978;51: 165-175.
- 16. Boutaybi N, Steggerda SJ, Smits-Wintjens VE, van Zwet EW, Walther FJ, Lopriore E. Early-onset thrombocytopenia in near-term and term infants with perinatal asphyxia. Vox Sang. 2014;106: 361-7.
- 17. Bick RL, Bick MD, Fekete LF. Antithrombin III Patterns in Disseminated Intravascular Coagulation. American Society of Clinical Pathologists 1990;71: 577-583.
- 18. Takagi M, Wada H, Tanigava M, et all. Measurement of FDP-D-dimer in DIC and pre- DIC. Rinsho Byori 1990;38: 806-812.
- 19. Bick RL, Baker WF. Diagnostic Efficacy of the D-dimer Assay in Disseminated Intravascular Coagulation ( DIC). Thromb res 1992;65: 785-790.
Abstract
Birçok
asfiktik bebeğin hastaneye kabulünde kanama sorunu bulunurken bazılarında takip
sırasında dissemine intravasküler koagülasyon (DİK) gelişmektedir. DİK
tedavisinde temel prensibin altta yatan problemin düzeltilmesi olduğu
bilinmekle birlikte pre-DİK döneminde tanı konulması, tedavisinin başarısı
açısından en önemli faktördür. Çeşitli çalışmalar ve hayvan deneyleri DİK
tablosu gelişmeden önce koagulasyon faktörlerinde bazı değişimler olduğunu
göstermektedir. Bu değişikliklerden birisi de antitrombin III ( AT III)
düzeylerinin azalmasıdır. Bu çalışmada;
asfiktik bebeklerde AT III düzeyleri ve AT III’ün asfiktik bebeklerde gelişen DİK
ile ilişkisinin araştırılması amaçlanmıştır. Çalışmaya doğumu izleyen ilk
saatlerde çeşitli derecelerden asfiksiye maruz kalmış 50 ve zamanında
komplikasyonsuz doğmuş sağlıklı 20 bebek alındı. Her iki grupta doğumu izleyen
ilk 12 saatte AT III, PT, PTT, D dimer düzeyi ve trombosit sayısı çalışıldı.
Takibinde DİK gelişen ve gelişmeyen bebeklerin başlangıç değerleri
karşılaştırılarak AT III’ün DİK’in erken tanısındaki değeri araştırıldı. Asfiktik
bebeklerin kontrol grubuna göre AT III düzeyleri ve trombosit sayıları düşük,
PT, PTT ve D dimer düzeyleri ise anlamlı şekilde yüksek idi. Takibi sırasında DİK
gelişen bebeklerin başlangıçta alınan AT III düzeyleri ( 14.01±5.11), DİK
gelişmeyenlere (19.03±2.74) göre anlamlı şekilde düşük idi ( P<0.05). D
dimer yüksekliği gösteren bebeklerin oranı DİK gelişen grupta %100 iken DİK
gelişmeyen grupta %55 olarak bulundu ve fark anlamlı idi. İki grubun PT, PTT ve
trombosit sayıları arasında anlamlı bir fark bulunmadı. Sonuç olarak; asfiktik
bebeklerde AT III düzeyleri sağlıklı bebeklere göre düşüktür ve DİK şüphesi
bulunan asfiktik bebeklerde AT III düzeyi tayininin, D dimer düzeyleri ile
birlikte pre-DİK evresinin bir göstergesi olabileceğini düşündürmektedir.
Keywords
References
- 1. Bona E, Hagberg H, Loberg EM, et al. Protective effects of moderate hypothermia after neonatal hypoxia-ischemia: short- and long-termoutcome. Pediatr Res. 1998; 43: 738–745.
- 2. Oncel MY, Erdeve O, Calisici E, et al. The effect of whole-body cooling on hematological and coagulation parameters in asphyxic newborns. Pediatr Hematol Oncol. 2013; 30: 246-52.
- 3. Vanucci RC. Hypoxic ischemic encephalopathy. Am J Perinatol. 2000;17: 113–120.
- 4. Küçüködük Ş. Yenidoğan ve Hastalıkları (1. Baskı). Feryal matbaası, Ankara 1994, ss 341- 381.
- 5. Phelan JP, Kirkendall C, KorstLM, MartinGI. Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment. J Matern Fetal Neonatal Med 2007; 20: 377-80.
- 6. Pugh M, Catherine L. DIC Screening in the Newborn. Neonatal Network 1997; 16: 57- 60.
- 7. Choudhry VP, Thavaraj V, Saraya AK. Disseminated Intra Vascular Coagulation: Diagnosis and Current Therapy. Indian Pediatrics 1990; 27: 280-288.
- 8. Mammen EF, Farag AA. The Role of Antithrombin III in DIC. Biologia&Clinica Hematologica 1987;9: 69-73.
- 9. Bick RL, Dukes ML, Wilson WL, Fekete LF. Antithrombin III ( AT-III) as a Diagnostic Aid in Disseminated Intravascular Coagulation. Thromb Res 1977;10: 721-729.
- 10. Bick RL. Clinical Relevance of Antithrombin III. Sem Thromb Hemost 1982;8: 276-285.
- 11. Peters M, Janseb E, Ten Cate JW, et al. Neonatal Antithrombin III. British J Haematol 1984;58: 579-287.
- 12. Fichera A, Pratico G, Sciacca F. Neonatal Hypoxia and Hemocoagulative Changes. Pediatr Med Chir 1989;11: 643-647.
- 13. Chadd MA, Elwood PC, Gray OP, Muxworthy SM. Coagulation Defects in Hypoxic Full- term Newborn Infants. Britsh Medical Journal 1971;4: 516- 518.
- 14. Schander K, Rehm A, Niesen M. Blood Coagulation Activity and Fibrinolysis in Umbilical Vein Blood of Healthy and Asphyxiated Newborn Infants. Fortschr Med 1977; 95: 1477- 1481.
- 15. McDonald TP, Cottrell M, Clift R. Effect of Short- Term Hypoxia on Platelet Counts of Mice. Blood 1978;51: 165-175.
- 16. Boutaybi N, Steggerda SJ, Smits-Wintjens VE, van Zwet EW, Walther FJ, Lopriore E. Early-onset thrombocytopenia in near-term and term infants with perinatal asphyxia. Vox Sang. 2014;106: 361-7.
- 17. Bick RL, Bick MD, Fekete LF. Antithrombin III Patterns in Disseminated Intravascular Coagulation. American Society of Clinical Pathologists 1990;71: 577-583.
- 18. Takagi M, Wada H, Tanigava M, et all. Measurement of FDP-D-dimer in DIC and pre- DIC. Rinsho Byori 1990;38: 806-812.
- 19. Bick RL, Baker WF. Diagnostic Efficacy of the D-dimer Assay in Disseminated Intravascular Coagulation ( DIC). Thromb res 1992;65: 785-790.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research article |
| Authors | |
| Publication Date | March 31, 2018 |
| Submission Date | January 5, 2018 |
| Acceptance Date | January 31, 2018 |
| Published in Issue | Year 2018 Volume: 3 Issue: 1 |
