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کزین برتر اندیشه بر نگذرد
بنام خداوند جان و خرد کزین برتر اندیشه بر نگذرد
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IRAN UNIVERSITY OF MEDICAL SCIENCE NEONATAL HEMATOLOGY CONGRESS
Dr FARHAD CHOOBDAR NEONATALOGIST IRAN UNIVERSITY OF MEDICAL SCIENCE NEONATAL HEMATOLOGY CONGRESS
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APPROACH TO NEONATAL THROMBOSIS
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OBJECTIVEo Understand why neonate may be at increase risk for THROMBOSIS How to evaluate THROMBOPHILIA
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THROMBOPHILIA INHERITED ACQUIRED ANTI-THROMBIN. def PROTEIN C&S .def
FACTOR-V LEIDEN. Mut PROTHROMBIN G20210.mut DYSFIBRINOGENEMIA HYPERHOMOCYSTEINEMIA (MTHFR.mut) ELEVATED FACTOR VIII ELEVATED LIPOPROTEIN A PAI-1 POLYMORPHISM ANTI PHOSPHOLIPID Ab .ACL Ab .ANTI β-2 GLYCOPROTEIN .ANTI-LA MAJOR MEDICAL CONDITION .INFLAMMATION .↑ CONSUMPTION .INVASIVE PROCEDURES
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W/U & LAB TEST D-dimer .breakdown of fibrin
.physiologically ↑ up to 1th 3day .sensitivity %96 .not specific .NPV : %93-96
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THROMBOPHILIA PANEL Factor V Laden Anti-Thrombin III Assay
Prothrombin Gene Mutation Protein C & S Level Homocystein Factor VIII Level Anti-Phospholipid Ab
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INDICATION Any unprovoked DVT Recurrent provoked DVT
Highly Recommended Any unprovoked DVT Recurrent provoked DVT Despite adequate prophylaxis DVT requiring catheter directed thrombolysis
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INDICATION Suggested CNS thrombosis Asymptomatic newborns with + F.Hx
Arterial thrombosis Recurrence of DVT with shorter duration of therapy(↓ 6 weeks)
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INDICATION Not Recommended
Clinically asymptomatic thrombosis Just radiographically detected
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Prior to initiating Heparin
Timing of sampling Prior to initiating Heparin D-dimer Anti-thrombin III Assay Factor VIII Level Lupus Anticoagulant
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Prior to initiating Warfarin
Timing of sampling Prior to initiating Warfarin Lupus Anticoagulant Protein C Protein S L
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IMAGING Ultrasound Non invasive Diagnosis Lack of compression
Lack of waveform response with respiration Echogenecity inside lumen
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Imaging-Ultrasonography
Lower. ext Upper.ext 95% sensitivity for proximal 50% for Calf limited ability to see iliac veins Sensitivity 54-100% Specificity 94-100% Technical difficulty
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