Thrombotic and bleeding disorders in perinatal medicine

Abstract

Hemostasis is a dynamic process, which evolves in-utero. The term “Developmental Haemostasis”, describes the age-related physiological changes of the coagulation system as it develops progressively over time from fetal, neonatal, pediatric to adult systems. In neonates and infants multiple reference samples are required to define the normal ranges of coagulation proteins for age, because these patients have rapidly evolving systems; blood sampling in the young is technically difficult; microtechniques are required and greater variability in plasma concentrations of coagulation proteins necessitates the use of large patient numbers to establish normative data. While acknowledging all these obstacles, Monagle et al. in the first manuscript of this special issue, focus on developmental changes in secondary haemostasis: the plasma coagulation and natural anticoagulant inhibitory protein changes that occur during the fetal and neonatal period. Whereas platelet number and volume are similar in neonates as compared to adult values, neonatal platelets certainly exhibit hypo-responsiveness. In the second manuscript addressing developmental primary hemostasis, Kenet et al. review platelet function, assessed by various techniques, and its development in the premature and healthy term neonate.