Van Cott E M, Grabowski E F
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Semin Thromb Hemost. 1998;24(6):583-90. doi: 10.1055/s-2007-996058.
This review considers differences in hemostasis among newborns, children, and adults from the standpoint of the vascular endothelium and, where appropriate, in the presence of flowing blood. Special procoagulant features of newborn hemostasis include unusually large von Willebrand factor multimers, augmented platelet transport under flow conditions, and greater ability of newborn endothelium to generate tissue factor. Special anticoagulant features in the newborn include increased vessel wall glycosaminoglycan activity, elevated alpha2-macroglobulin, and increased percentage of free protein S. The net effect of the differences is that hemostasis is generally achieved in all age groups but is developmental in nature. In addition to congenital hypercoagulable states and catheter placement, developmental vascular anomalies appear to constitute a thrombotic risk, at least in some children (and possibly adults).
本综述从血管内皮的角度，并在适当考虑血流存在的情况下，探讨了新生儿、儿童和成人在止血方面的差异。新生儿止血的特殊促凝特征包括异常大的血管性血友病因子多聚体、在流动条件下增强的血小板转运，以及新生儿内皮细胞产生组织因子的能力更强。新生儿的特殊抗凝特征包括血管壁糖胺聚糖活性增加、α2-巨球蛋白升高以及游离蛋白S百分比增加。这些差异的总体影响是，所有年龄组通常都能实现止血，但本质上是发育性的。除了先天性高凝状态和导管置入外，发育性血管异常似乎也构成血栓形成风险，至少在一些儿童（可能还有成人）中如此。
