The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies

Peter H. Shaw, Stacy Reynolds, Sriya Gunawardena, Lakshamanan Krishnamurti, Arthur Kim Ritchey

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We evaluated the prevalence of hemostatic disorders among pediatric patients with abnormal screening coagulation tests. Procedure: We analyzed 48 consecutive referrals for abnormal prothrombin times, partial thromboplastin times, or closure times obtained as preprocedural screens. Patients were evaluated by uniform diagnostic testing. Results: Seventeen patients (35%) had an isolated nonspecific inhibitor (NSI). Six patients (12.5%) presented with mildly low factor activity with a concomitant NSI. These deficiencies were of unclear clinical significance. One patient (2%) had a lupus anticoagulant. Only 9 patients (19%) had a possible or true mild bleeding disorder: 5 patients (10%) had isolated low von Willebrand factor levels, 2 patients (4%) had possible type I von Willebrand disease, and 2 (4%) had platelet aggregation disorders. In all patients, personal and family bleeding history had a positive predictive value of 45% for hemostatic disorders. Conclusions: The most common diagnosis among the patients referred to us for abnormal preoperative coagulation tests was a NSI, which is not associated with an increased risk of operative bleeding complications. Less than 20% had a possible or true mild bleeding disorder. Although certain bleeding disorders can be occult in children and are associated with perioperative bleeding risks, our study demonstrates the inherent limitations in making a laboratory diagnosis of a bleeding disorder in pediatric patients preoperatively. Our findings contribute to existing doubt about the usefulness of prothrombin times, partial thromboplastin times, and closure times to identify occult bleeding disorders in this population.

Original languageEnglish (US)
Pages (from-to)135-141
Number of pages7
JournalJournal of Pediatric Hematology/Oncology
Volume30
Issue number2
DOIs
StatePublished - Feb 2008
Externally publishedYes

Keywords

  • Bleeding
  • Children
  • Coagulation abnormalities
  • Lupus anticoagulants
  • Preoperative screen
  • Von Willebrand disease

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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