G367(P) Coagulation screens: indications, abnormalities, management and follow up in a general paedaitric unit

Abstract

Aims To identify: Clinical indications for performing coagulation screens. Abnormalities found in coagulation screens. Management and follow up of abnormal coagulation screens. Method A retrospective case note review of patients aged 0–16 years who had a coagulation screen during a 6 month period from 1 st January until 30th June 2017. Results 219 samples were analysed. 45% (n=99) were male and 55% (n=120) female, aged 4 days to 16 years. The most common indication for performing a coagulation screen was presence of a non-blanching rash 32% (n=71). Bloody diarrhoea 7% (n=19), paracetamol overdose 7% (n=15) and child protection medicals 5% (n=12) were the next most common indications. 66.7% (n=146) of samples had at least one abnormality. 29% (n=64) of prothrombin times (PT), 25% (n=55) of activated partial thromboplastin time (APTT) and 35% (n=81) thrombin times (TT) were outwith the normal values for age. 62% (n=91) had mildly abnormal results. Abnormal results were commonest in the 1 to 5 year old group 32% (n=47). In those with mildly abnormal results repeat samples were arranged in 16% (n=15), whereas in coagulation screens with greater abnormalities repeat sampling was arranged in 55% (n=30). Repeat samples were carried out at a median of 7 days from the original sample (range 0–129 days). One patient received i.v. vitamin K for prolonged PT and 3 patients were referred to haematology. Two of who had family members with a clotting disorder and one had a new diagnosis of haemophilia B. Conclusions The commonest reason for performing a coagulation screen was a non–blanching rash. The commonest abnormality is a prolonged TT, followed by PT then APTT. There is wide variability in follow up and timing of follow up of abnormal coagulation screens. Children with mildly abnormal screens are least likely to have repeat sampling. Recommendation 1. To develop a guideline to unify the follow up of abnormal coagulation screens.