Coagulation abnormalities in neonatal sepsis - a diagnostic approach
Abstract
Objectives: To assess the predictive role of coagulation activation markers in identifying haemostatic derangements in Neonatal sepsis and to compare levels of Fibrinogen degradation products (FDP`s) and D-dimers for early diagnosis of disseminated intravascular coagulation (DlC). Study design: A cross-sectional descriptive study. Place and duration: Neonatology Units of Sir Ganga Ram Hospital, Services Hospital and Children Hospital Lahore, in six months i.e. from August 2003 to January 2004. Subjects and methods: Sixty (60) cases of blood culture proven neonatal sepsis were studied for markers of coagulation activation including, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen degradation products (FDPs), D-dimers, fibrinogen level assay and platelet counts. Thirty (30) healthy age matched neonates served as control group. Results: Prolonged PT was most frequent finding with a range of 14-163 sec (SD+ mean 37±25 sec) (control 12-22 sec (18.46±2.86 sec) (P<.001). APTT among septic neonates ranged between 28-136 sec(59.31+27.08) versus APTT of control group ranging between 21-62 sec (43.43+10.9) with P<.01. Fibrinogen assay ranged between 35-600mg/dl (241.86±143.64), (Control 210-480mg/dI (297.66+67+1.85), (P<.01). Twenty seven (43.3%) cases revealed hypofibrinogenemia. FDPs among septic neonates were raised in 41(68.34%) cases whereas, D-dimers was high in 43(71.67%) cases. Platelet counts showed range of 20- 434x10/ul (171.58+101.6) in septic group versus range of 160-448x10/ul (266.47+86.06) in control group with P<0.001. Thrombocytopenia was detected in 21(35%) cases. A diagnosis of non-overt DlC was made in 5(8.3%) cases whereas one case (1.65%) had overt DlC. Conclusion: Prolonged PT is the most consistent indicator of haemostatic derangement, followed by increased levels of D-dimers. Later proved to be a more sensitive indicator of coagulation activation than FDPs estimation. Prolonged APTT, Thrombocytopenia and hypotibrinogenemia, when present, indicated serious compromise of haemostasis.Downloads
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Copyright (c) 2016 Shabnam Bashir, Mohammad Tayyib, Noshin Wasim Yousef
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