The Bleeding Neonate - A Diagnostic Algorithm.pdf

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1. The bleeding neonate –
a diagnostic algorithm
DR G RAM MOHAN

2. Objectives
INTRODUCTION
ETIOLOGY
DIAGNOSTIC TESTS
DIAGNOSTIC ALGORITHM
MANAGEMENT

3. INTRODUCTION
Name Synonym
Factor I fbrinogen
Factor II prothrombin
Factor III tissue factor
Factor IV calcium
Factor V proaccelerin, labile factor
Factor VI old name of Factor Va
Factor VII proconvertin, stable factor
Factor VIII antihemophilic factor A
Factor IX antihemophilic factor B
Factor X Stuart-Prowerfactor
Factor XI plasma thromboplastin antecedent
Factor XII Hagemenfactor
Factor XIII fibrin-stabilizing factor

4. Primary hemostasis(platelet
plug)
Secondary hemostasis
(clotting cascade )

8. Etiology
DIC
LIVER FAILURE
VKDB
Hemophilia
vWD
(Rare) other Factor deficiencies

9. HEALTH STATUS TERMINOLOGY
SICK neonates
HR, RR, Retractions,
cyanosis,grunting
,shallow breathing
,apnea, gasping,
hypothermia,
hyperthermia, pale or
jaundiced , lethargy ,
poor feeding
Healthy or well neonates
Vs

10. Neonatal bleeding syndromes
Pulmonary hemorrhage
Gastro intestinal hemorrage
Subgaleal
Retroperitoneal
Skin hemorrhage
Petechiae :platelets
Palpable hematomas : coagulation factor deficiency

11. DIAGNOSTIC TESTS
CBP
PT ,INR
aPTT
Mixing studies
Fibrinogen
Fibrin degradation products
D dimers
TEG (Thromboelastography)
ROTEM (Rotational thromboelastometry)
Apt test (1% Na OH)-PSEUDOHEMORRAGE IN A NEONATE

13. DIC SCORE
Interpretation:
• ≥ 4 points:
symptoms: overt DIC
no symptoms: non-overt DIC;
• 3 points: suspected DIC;
• ≤ 2 points: low possibility for
DIC.

14. DIC vs LIVER FAILURE
Stable low platelet counts
Mildly increased D Dimers
Stable factor XIII levels

15. Treatment modalities
Goal : maintain minimum hemostaticconcentration of key blood components
Vitamin K
Platelet transfusion (PlaNetTrial 25000 vs 50000)(10ml/kg 50000 increase)
FFP ( factor deficiencies vs abnormal PT and a PTT)
Cryoprecipitate (10ml per kg 50mg/dl of fibrinogen)
Recombinant Factor supplements
Treat underlying cause
Repeat test after 1hr and 24 hrs later to assess response

16. TAKE HOME MESSAGES
Neonatal hemostasisis peculiar and the neonate is in a continuous state of developmental
hemostasis
Distinguish whether neonate is sick or not
Rule out DIC vs thrombocytopenia
Be aware of clotting factor deficiency to be presented In neonatal period
Maintain minimum hemostaticconcentration of key blood components

17. Thank u