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新生儿脐带血和外周血中标准止血检测与整体止血检测的比较。

Comparison of standard and global hemostasis assays in cord and peripheral blood of newborns.

作者信息

Arutunyan Belinda V, Koltsova Ekaterina M, Shpilyuk Margarita A, Lipets Elena N, Timofeeva Leila A, Karavaeva Anna L, Balashova Ekaterina N, Krechetova Liubov V, Ataullakhanov Fazoil I, Zubkov Viktor V, Degtyarev Dmitry N, Sukhikh Gennady T, Tetruashvili Nana K, Balandina Anna N

机构信息

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician Kulakov V.I., Moscow, 117997, Russia.

Center for Theoretical Problems of Physicochemical Pharmacology RAS, Moscow, 109029, Russia.

出版信息

Pediatr Res. 2025 Apr;97(5):1732-1741. doi: 10.1038/s41390-024-03475-y. Epub 2024 Aug 17.

DOI:10.1038/s41390-024-03475-y
PMID:39154143
Abstract

BACKGROUND

Umbilical cord blood is used for the testing of various parameters in newborns. However, data on its applicability for hemostasis assays is insufficient.

OBJECTIVE

To evaluate whether umbilical cord blood can be used for standard tests, thromboelastometry and thrombodynamics for preterm and term newborns.

METHODS

187 newborns were included in the study. Blood was taken from the umbilical cord and by venipuncture of the newborn. Clotting times, fibrinogen, D-dimer, thromboelastometry and thrombodynamics were measured.

RESULTS

Clotting times and fibrinogen indicated a hypocoagulable shift, while thromboelastometry and thrombodynamics showed a hypercoagulable shift in hemostasis in umbilical cord blood compared to newborn blood. D-dimer indicated an enhanced process of thrombus lysis in newborn blood compared to cord blood. Collecting blood into a tube with the addition of a contact pathway inhibitor did not significantly change the global assay parameters in either umbilical cord blood or newborn blood. In the thrombodynamics assay, spontaneous clotting was detected but suppressed by the addition of a tissue factor inhibitor.

CONCLUSIONS

Hemostasis in cord and newborn blood differs for both global and standard tests. Hypercoagulability in newborns registered with the global assay thrombodynamics is associated with the presence of tissue factor in the blood.

IMPACT STATEMENT

  1. We found a hypercoagulation shift in newborns compared with the adult references, possibly due to the presence of tissue factor in blood. 2. Blood coagulation is enhanced in cord blood compared with blood sampled from the vein of a newborn according to thromboelastometry and thrombodynamics assays. 3. Clotting times and fibrinogen concentrations in cord blood differ from these parameters in newborn blood. 4. Studying of the (patho)physiological features of hemostasis in newborns should consider differences in cord blood and vein sampled blood.
摘要

背景

脐带血用于检测新生儿的各种参数。然而，关于其在止血检测中的适用性数据不足。

目的

评估脐带血是否可用于早产儿和足月儿的标准检测、血栓弹力图和血栓动力学检测。

方法

187名新生儿纳入本研究。从脐带和新生儿静脉穿刺采集血液。测量凝血时间、纤维蛋白原、D - 二聚体、血栓弹力图和血栓动力学。

结果

与新生儿血液相比，脐带血的凝血时间和纤维蛋白原显示低凝倾向，而血栓弹力图和血栓动力学显示止血方面的高凝倾向。与脐带血相比，新生儿血液中的D - 二聚体表明血栓溶解过程增强。将血液收集到添加接触途径抑制剂的试管中，脐带血和新生儿血液的整体检测参数均未发生显著变化。在血栓动力学检测中，检测到自发凝血，但添加组织因子抑制剂可抑制该现象。

结论

脐带血和新生儿血液在整体和标准检测中的止血情况不同。通过整体检测血栓动力学检测出的新生儿高凝性与血液中组织因子的存在有关。

影响声明

  1. 我们发现与成人参考值相比，新生儿存在高凝转变，可能是由于血液中存在组织因子。2. 根据血栓弹力图和血栓动力学检测，脐带血中的血液凝固比从新生儿静脉采集的血液增强。3. 脐带血中的凝血时间和纤维蛋白原浓度与新生儿血液中的这些参数不同。4. 研究新生儿止血的（病理）生理特征应考虑脐带血和静脉血之间的差异。

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Coagulation parameters in the newborn and infant - the Copenhagen Baby Heart and COMPARE studies.新生儿和婴儿的凝血参数——哥本哈根婴儿心脏和 COMPARE 研究。
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