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Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth?
Author(s) -
Raffaeli Genny,
Tripodi Armando,
Manzoni Francesca,
Scalambrino Erica,
Pesenti Nicola,
Amodeo Ilaria,
Cavallaro Giacomo,
Villamor Eduardo,
Peyvandi Flora,
Mosca Fabio,
Ghirardello Stefano
Publication year - 2020
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.15785
Subject(s) - partial thromboplastin time , medicine , thromboelastography , fibrinogen , hemostasis , prothrombin time , venous blood , antithrombin , gestational age , thrombophilia , thrombin time , coagulation testing , obstetrics , coagulation , anesthesia , pregnancy , thrombosis , heparin , biology , genetics
ABSTRACT BACKGROUND Phlebotomy is among the main determinants of anemia of prematurity. Blood sparing policies endorsed umbilical cord blood (here called placental) as an alternative source for laboratory testing. Little is known on the suitability of placental blood to evaluate neonatal hemostasis of newborn infants. We aimed to compare the hemostatic profile of paired placental and infant venous blood, by means of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, protein C, thromboelastography (TEG) and thrombin generation assay (TGA). STUDY DESIGN This was an observational single‐center study. METHODS We collected at birth venous citrated blood from both placental and infant venous source and performed PT, APTT, fibrinogen, antithrombin, protein C, TEG (reaction time‐R; kinetics‐K alpha angle‐α, maximum amplitude‐MA and lysis at 30 minutes‐LY30), and TGA (endogenous thrombin potential‐ETP). RESULTS We enrolled 60 neonates with a median gestational age (range) of 37 weeks (28 +1 ‐41) and birth‐weight 2417 g (950‐4170). Based on TEG and TGA, placental blood showed a procoagulant imbalance as indicated by lower median R (4.0 vs. 6.1 min; p < 0.001) and K (1.3 vs. 2.2 min; p < 0.001); higher α‐angle (69.7 vs. 57.4°; p < 0.001) and ETP (1260 vs. 1078; p = 0.002) than those observed for infant venous blood. PT and APTT did not differ significantly between the two groups. CONCLUSIONS While placental and neonatal blood samples are equally suitable to measure the standard coagulation tests PT and APTT, placental blood leads to a procoagulant imbalance when testing is performed with TEG or TGA. These effects should be considered when interpreting results stemming from investigation of neonatal hemostasis.