Hemostasis in congenital heart disease

A study of the hemostatic status of twenty- five patients with cyanotic congenital heart disease, [Group I] twenty patients with congenital acyanotic heart disease [Group II] was undertaken to define the coagulation abnormalities in the cardiac patients when compared to fifteen control children [Group III] of similar age and sex. A significant prolonged bleeding time, prothrombin time, thrombin time was proved in the cyanotic congenital heart group when compared to the control group, Thrombocytopenia, a significant decrease in platelet aggregation with ADP and also a significant decrease in plasma fibrinogen and fibrin degradation product [F.D.P] as shown in Group I, Plasma Anti-thrombin- III [ATIII], plasma total and free protein S levels, protein C levels showed a non significant change in congenital cyanotic heart. The only abnormality in acyanotic patient was a slightly prolonged bleeding time and prothrombin time not statistically significant. Because of the abnormal hemostasis in congenital cyanotic heart disease, each child must be studied and considered separately prior to surgery

Newborn haemostasis

A study of the coagulation system of twenty full term, fifteen premature were compared to twenty normal adults receiving no medication. The fibrinogen level is proved to be normal in fullterm [274 +/- 61 mg/dl] and preterm infants [268 +/- 64 mg/ dl] when compared to the adult group [283 +/- 58 mg/dl]. Prothrombin and protein C are vitamin-K dependent proteins with important roles in haemostasis. The work showed that levels of both proteins are significantly lower than the adult and related to gestational age. Protein C level in the full term [45.6 +/- 10.2], premature [35.5 +/- 6.8] was lower than the adult [95.6 +/- 8.4] also the prothrombin level in the full term [60.4 +/- 12.9], premature [41.3 +/- 5.4] was low when compared to the adult [98.9 +/- 4.1]. A deficiency of antithrombin 111 in the newborn [59.5 +/- 14.3], preterm [41.2 +/- 12.2] is shown by comparison to the adult [89.7 +/- 10.1], the level of antithrombin III in the neonate is commensurate with the level of the vitamin K factors that it inhibits. So normally there is a delicate balance between procoagulants and inhibitors of clotting mechanism in infants. The normal ranges of the levels of prothrombin, protein C, Anti 111, total and free protein S have to be studied in later infancy and the age at which adult levels are reached need to be established

Serum cord prolactin levels in infants of diabetic preeclamptic mothers

Serum prolactin was measured by R I A. in mixed cord of 18 infants of diabetic mothers [I D.M], 18 infants of pergnancy induced hypertension compared to 20 normal full term newborns. The cord prolactin level of infants of women with pregnancy induced hypertension was higher 345 +/- 34.2 ng/ml when compared to cord blood of full term infants 280 +/- 20.4 ng/ml. Infants of diabetic mothers had significantly lower mixed cord serum prolactin levels than control infants 220 +/- 15 ng/ml versus 280 +/- 20.4 ng/ml [less than 0.001]. Fetal Apgar score was lower in I D.M. than controls more significant at one minute than 5 minutes. One infant from the 18 infants of diabetic mothers was reported to develop respiratory distress syndrome [R D.S] with serum prolactin 150 ng/ml, estradiol 5.9 ng/ml, cortisol 68 ng/ml. Serum prolactin considered one of the several hormones responsible for fetal lung maturation was found to be lower in I D.M. than control. These findings raise the possibility than decreased fetal prolactin levels may be associated with or contribute to, the delayed lung maturation reported with diabetic pregnancies