Rheumatoid Arthritis With Multiple Lung Nodules: A Case Report.

Rheumatoid arthritis (RA) is an inflammatory multisystemic disease characterized by erosive arthritis with many extra-articular manifestations. Pleuropulmonary manifestations are frequently seen in patients with RA. Risk factors include male gender, severe erosive arthritis, high titers of rheumatoid factor, subcutaneous nodules, smoking, genetic predisposition, and the presence of other extra-articular manifestations of RA. We report a patient known to have RA presenting with multiple lung nodules. A 35-year-old female patient, known to have seropositive RA, was diagnosed 10 years ago. She was on oral corticosteroids (OCS) 5 mg daily, Upadacitinib 15 mg daily, and methotrexate (MTX) 20 mg weekly. The patient was referred for pulmonary medicine evaluation because of the finding of multiple lung nodules on chest imaging. A routine chest X-ray conducted as a part of the general evaluation showed a nodular opacity in the right lower lobe. Subsequently, a high-resolution CT (HRCT) scan of the chest was carried out and showed multiple pulmonary nodules. At the time of evaluation, she had no active respiratory symptoms with no signs of respiratory distress. As she was an active smoker, the decision was to proceed with a CT-guided biopsy besides full clinical, hematological, biochemical, and microbiological evaluations. The histopathological findings suggested a rheumatoid nodule with no evidence of malignant or infectious causes. No specific therapy was added at the time being, and the patient was monitored with regular follow-ups. Differentiation of rheumatoid lung nodules from other causes, such as malignancy and infectious causes, is essential. A biopsy with histopathological evaluation is a must in those with a high likelihood of malignancy, such as smokers. In addition to that, comprehensive clinical, hematological, microbiological, and radiological evaluations are required. Rheumatoid lung nodules are usually asymptomatic, with no specific therapy needed apart from the general management of RA with glucocorticoid, immunosuppressive, and biologic therapies.

Laboratory evaluation of the miniature direct-on-blood PCR nucleic acid lateral flow immunoassay (mini-dbPCR-NALFIA), a simplified molecular diagnostic test for Plasmodium.

BACKGROUND: Point-of-care diagnosis of malaria is currently based on microscopy and rapid diagnostic tests. However, both techniques have their constraints, including poor sensitivity for low parasitaemias. Hence, more accurate diagnostic tests for field use and routine clinical settings are warranted. The miniature direct-on-blood PCR nucleic acid lateral flow immunoassay (mini-dbPCR-NALFIA) is an innovative, easy-to-use molecular assay for diagnosis of malaria in resource-limited settings. Unlike traditional molecular methods, mini-dbPCR-NALFIA does not require DNA extraction and makes use of a handheld, portable thermal cycler that can run on a solar-charged power pack. Result read-out is done using a rapid lateral flow strip enabling differentiation of Plasmodium falciparum and non-falciparum malaria infections. A laboratory evaluation was performed to assess the performance of the mini-dbPCR-NALFIA for diagnosis of pan-Plasmodium and P. falciparum infections in whole blood. METHODS: Diagnostic accuracy of the mini-dbPCR-NALFIA was determined by testing a set of Plasmodium-positive blood samples from returned travellers (n = 29), and Plasmodium-negative blood samples from travellers with suspected malaria (n = 23), the Dutch Blood Bank (n = 19) and intensive care patients at the Amsterdam University Medical Centers (n = 16). Alethia Malaria (LAMP) with microscopy for species differentiation were used as reference. Limit of detection for P. falciparum was determined by 23 measurements of a dilution series of a P. falciparum culture. A fixed sample set was tested three times by the same operator to evaluate the repeatability, and once by five different operators to assess the reproducibility. RESULTS: Overall sensitivity and specificity of the mini-dbPCR-NALFIA were 96.6% (95% CI, 82.2%-99.9%) and 98.3% (95% CI, 90.8%-100%). Limit of detection for P. falciparum was 10 parasites per microlitre of blood. The repeatability of the assay was 93.7% (95% CI, 89.5%-97.8%) and reproducibility was 84.6% (95% CI, 79.5%-89.6%). CONCLUSIONS: Mini-dbPCR-NALFIA is a sensitive, specific and robust method for molecular diagnosis of Plasmodium infections in whole blood and differentiation of P. falciparum. Incorporation of a miniature thermal cycler makes the assay well-adapted to resource-limited settings. A phase-3 field trial is currently being conducted to evaluate the potential implementation of this tool in different malaria transmission areas.

Sepsis-Induced Coagulopathy: An Update on Pathophysiology, Biomarkers, and Current Guidelines.

Significant cross talk occurs between inflammation and coagulation. Thus, coagulopathy is common in sepsis, potentially aggravating the prognosis. Initially, septic patients tend to exhibit a prothrombotic state through extrinsic pathway activation, cytokine-induced coagulation amplification, anticoagulant pathways suppression, and fibrinolysis impairment. In late sepsis stages, with the establishment of disseminated intravascular coagulation (DIC), hypocoagulability ensues. Traditional laboratory findings of sepsis, including thrombocytopenia, increased prothrombin time (PT) and fibrin degradation products (FDPs), and decreased fibrinogen, only present late in the course of sepsis. A recently introduced definition of sepsis-induced coagulopathy (SIC) aims to identify patients at an earlier stage when changes to coagulation status are still reversible. Nonconventional assays, such as the measurement of anticoagulant proteins and nuclear material levels, and viscoelastic studies, have shown promising sensitivity and specificity in detecting patients at risk for DIC, allowing for timely therapeutic interventions. This review outlines current insights into the pathophysiological mechanisms and diagnostic options of SIC.

Laboratory evaluation of a new alphacypermethrin long-lasting insecticidal net against Anopheles culicifacies s.l.

Long-lasting insecticidal nets (LLINs) are being promoted by World Health Organization (WHO) as key vector control tool for the prevention and control of malaria and other vector-borne diseases. A laboratory study was conducted to evaluate the bio-efficacy of a new alphacypermethrin LN (HILNET®) against insecticide-susceptible Anopheles culicifacies s.l.. This study presents the observations on (a) regeneration time, the period required to regenerate insecticide in the LLIN after three consecutive WHO standard washes in a single day to deplete the insecticide on the net surface, and (b) wash resistance of the LLIN to retain bio-efficacy up to 20 repeated washes at intervals corresponding to the regeneration time in days. In the present evaluation, the regeneration time of HILNet® was determined as 2 days. Wash resistance studies of HILNet® showed a knockdown rate of 100% up to 15 washes and 97% at the 20th wash and complied with the criteria of WHO knockdown rate of ≥ 95%. The mean active ingredient content from 0 to 20 washes was in the range of 5.8 to 6.04 g/kg and met the WHO criteria of the product claim (± 25% g/kg). The insecticide un-impregnated control net has shown no detectable levels of alphacypermethrin. In this evaluation, HILNet® fulfilled the WHO laboratory (phase I) efficacy criteria based on the rates of knockdown up to 20 standard WHO washes.

Mild abusive head injury: diagnosis and pitfalls.

Clinicians often miss making the diagnosis of abusive head injury in infants and toddlers who present with mild, non-specific symptoms such as vomiting, fussiness, irritability, trouble sleeping and eating, and seizure. If abusive head injury is missed, the child is likely to go on to experience more severe injury. An extensive review of the medical literature was done to summarize what is known about missed abusive head injury and about how these injuries can be recognized and appropriately evaluated. The following issues will be addressed: the definition of mild head injury, problems encountered when clinicians evaluated mildly ill young children with non-specific symptoms, the risk of missing the diagnosis of mild abusive head trauma, the risks involved in subjecting infants and young children to radiation and/or sedation required for neuroimaging studies, imaging options for suspected neurotrauma in children, clinical prediction rules for evaluating mild head injury in children, laboratory tests than can be helpful in diagnosing mild abusive head injury, history and physical examination when diagnosing or ruling out mild abusive head injury, social and family factors that could be associated with abusive injuries, and interventions that could improve our recognition of mild abusive head injuries. Relevant literature is described and evaluated. The conclusion is that abusive head trauma remains a difficult diagnosis to identify in mildly symptomatic young children.

THYROID DYSFUNCTION IN WOMEN OF REPRODUCTIVE AGE: LABORATORY PROTOCOL FOR INFERTILITY EVALUATION.

Background: Infertility in developing counties worldwide is associated with many social, financial, and medical challenges. With a prevalence rate of between 10 - 14 % and biochemical etiology of about 80% of the cases among Nigerian women, laboratory diagnosis has gradually assumed an important role in improved diagnosis. Objective: The aim was to evaluate the prevalence of thyroid dysfunction in infertility and need to evaluate. Methods: This was a descriptive cross-sectional case study of one hundred and twenty-five (125) women selected by stratified random sampling method into two groups of primary and secondary infertility. A total of 125 healthy fertile women served as the control group. Serum freeT3 (fT3), feeT4 (fT4), and TSH were analyzed using commercial ELISA kits. Data were analyzed using SPSS version 20.0 and the p-value of ≤0.05 was considered statistically significant. Results: Twenty participants (16%) were observed to have associated thyroid dysfunction with infertility. The commonest thyroid dysfunction was overt hypothyroidism (9.6%) and subclinical hypothyroidism (4.0%) respectively and this was found to be commoner in secondary infertility (21.8%). Conclusion: Thyroid function evaluation (especially serum TSH) should be included as a routine assessment in infertility protocol, especially in secondary infertility cases.

Laboratory Evaluation of Mechanical Properties of Modified Asphalt and Mixture Using Graphene Platelets (GnPs).

Recently, nanomaterials have attracted attention in the field of pavement construction as modifiers to endure heavy loads and climate changes. In this study, conventional asphalt (bitumen) of penetration grade AC (60/70) was modified with graphene platelets (GnPs) at three different contents: 0.5%, 1.0%, and 1.5% by weight of asphalt content. Kinematic viscosity, softening point, penetration, and dynamic shear rheology tests were performed to evaluate the mechanical properties of modified binder. The results showed that adding GnPs improves the mechanical properties of asphalt binder; the kinematic viscosities, softening points, and rutting parameters increased but penetrations decreased with the contents of GnPs. Hot mix asphalt specimens with GnPs-modified asphalt were prepared and characterized with Marshall tests, thermal stress restrained specimen tests (TSRST), wheel tracking tests, and indirect tensile tests. Similar to the results of asphalt binder, the mechanical properties of asphalt mixture were improved by GnPs. Marshall stability increased by 21% and flow decreased by 24% with accepted value of 2.8 mm in penetration when the mixture was modified with 1.0 wt% of GnPs. At the same GnPs content, modified asphalt mixture led to lower failure temperature by 2 °C in comparison with unmodified asphalt mixture and the cryogenic failure stress was improved by 12%. The wheel tracking tests showed that GnPs-modified asphalt mixture has outstanding deformation resistance in comparison with unmodified asphalt mixtures: after 5000 cycles, 1.0 wt% of GnPs reduced the rut depth of asphalt mixture by 60%-the rut depth of unmodified asphalt mixture was 6.9 mm compared to 2.75 mm for modified asphalt mixture. After 10,000 cycles, the modified asphalt mixture showed rut depth of 3.24 mm in comparison with 8.12 mm in case of unmodified asphalt mixture. Addition of GnPs into asphalt mixture significantly improved the indirect tensile strength: 1.0 wt% of GnPs increased the indirect tensile strength of unmodified asphalt mixture from 0.79 to 1.1 MPa recording ~40% increment. The results of this study can confirm that graphene platelets enhance the mechanical properties of asphalt mixture and its performance.

Laboratory evaluation of two point-of-care detection systems for early and accurate detection of influenza viruses in the Lao People's Democratic Republic.

BACKGROUND: We evaluated molecular-based point-of-care influenza virus detection systems in a laboratory prior to a field evaluation of on-site specimen testing. METHODS: The performance characteristics of 1) insulated isothermal polymerase chain reaction (PCR) on a POCKIT™ device and 2) real-time reverse transcription-PCR (rRT-PCR) on a MyGo Mini™ device were evaluated using human clinical specimens, beta-propiolactone-inactivated influenza viruses, and RNA controls. The rRT-PCR carried out on a CXF-96™ real-time detection system was used as a gold standard for comparison. RESULTS: Both systems demonstrated 100% sensitivity and specificity and test results were in 100% agreement with the gold standard. POCKIT™ only correctly identified influenza A (M gene) in clinical specimens due to the unavailability of typing and subtyping reagents for human influenza viruses, while MyGo Mini™ had either a one log higher or the same sensitivity in detecting influenza viruses in clinical specimens compared to the gold standard. For inactivated viruses and/or viral RNA, the analytic sensitivity of POCKIT™ was shown to be comparable to, or more sensitive, than the gold standard. The analytic sensitivity of MyGo Mini™ had mixed results depending on the types and subtypes of influenza viruses. CONCLUSIONS: The performance of the two systems in a laboratory is promising and supports further evaluation in field settings.

The Investigation of the Cardiovascular and Sudomotor Autonomic Nervous System-A Review.

The autonomic nervous system as operating system of the human organism permeats all organ systems with its pathways permeating that it is involved with virtually all diseases. Anatomically a central part, an afferent part and sympathetic and parasympathetic efferent system can be distinguished. Among the different functional subsystems of the autonomic nervous system, the cardiovascular autonomic nervous system is most frequently examined with easily recordable cardiovascular biosignals as heart rate and blood pressure. Although less widely established, sudomotor tests pose a useful supplement to cardiovascular autonomic assessment as impaired neurogenic sweating belongs to the earliest clinical signs of various autonomic neuropathies as well as neurodegenerative disorders and significantly reduces quality of life. Clinically at first, the autonomic nervous system is assessed with a detailed history of clinical autonomic function and a general clinical examination. As a lof of confounding factors can influence autonomic testing, subjects should be adequately prepared in a standardized way. Autonomic testing is usually performed in that way that the response of the autonomic nervous system to a well-defined challenge is recorded. As no single cardiovascular autonomic test is sufficiently reliable, it is recommended to use a combination of different approaches, an autonomic test battery including test to measure parasympathetic and sympathetic cardiovascular function (deep breathing test, Valsalva maneuver, tilt, or pressor test). More specialized tests include carotid sinus massage, assessment of baroreceptor reflex function, pharmacological tests or cardiac, and regional hemodynamic measurements. Techniques to measure functional integrity of sudomotor nerves include the quantitative sudomotor axon reflex sweat test, analysis of the sympathetic skin response as well as the thermoregulatory sweat test. In addition to these rather established techniques more recent developments have been introduced to reduce technical demands and interindividual variability such as the quantitative direct and indirect axon reflex testing or sudoscan. However, diagnostic accuracy of these tests remains to be determined. We reviewed the current literature on currently available autonomic cardiovascular and sudomotor tests with a focus on their physiological and technical mechanisms as well as their diagnostic value in the scientific and clinical setting.

The chemical and laboratory investigation of hemolysis.

The abnormal breakdown of circulating red blood cells (RBCs), also known as hemolysis, is a significant clinical issue that can present as a primary disorder or arise secondary to another disease process. The evaluation for pathologic hemolysis (and the establishment of a hemolytic disorder) is heavily dependent on assays performed and overseen by the divisions of Hematology, Blood Bank/Transfusion Medicine, Clinical Chemistry, and Immunology in the clinical laboratory. Because of the wide variety of assays used across the spectrum of clinical pathology and potential pitfalls/limitations associated with this testing, the decision of which assay to choose and, perhaps more importantly, how to interpret results, can both be quite challenging. Thus, the aim of this manuscript is to provide a comprehensive review on the laboratory investigation of pathologic forms of hemolysis and hemolytic disorders. This chapter will: (1) introduce basic concepts on the pathophysiology of hemolysis and (2) examine assays available for hemolysis on a laboratory-by-laboratory basis, with a particular emphasis on the strengths, limitations, and clinical interpretations of each of these assays.

Laboratory Evaluation on Performance of Eco-Friendly Basalt Fiber and Diatomite Compound Modified Asphalt Mixture.

This study proposed an asphalt mixture modified by basalt fiber and diatomite. Performance of diatomite modified asphalt mixture (DAM), basalt fiber modified asphalt mixture (BFAM), diatomite and basalt fiber compound modified asphalt mixture (DBFAM), and control asphalt mixture (AM) were investigated by experimental methods. The wheel tracking test, low-temperature indirect tensile test, moisture susceptibility test, fatigue test and freeze⁻thaw cycles test of four kinds of asphalt mixtures were carried out. The results show that the addition of basalt fiber and diatomite can improve the pavement performance. Diatomite has a significant effect on the high temperature stability, moisture susceptibility and resistance to moisture and frost damage under freeze⁻thaw cycles of asphalt mixture. Basalt fiber has a significant effect on low-temperature cracking resistance of asphalt mixture. Composed modified asphalt mixture has obvious advantages on performance compared to the control asphalt mixture. It will provide a reference for the design of asphalt mixture in seasonal frozen regions.

A comparison of 24 chemicals in the six-well bacterial reverse mutation assay to the standard 100-mm Petri plate bacterial reverse mutation assay in two laboratories.

The bacterial reverse mutation assay (Ames) is a fundamental genetic toxicology test, and efforts to miniaturize the regulatory GLP version are essential in assessing genotoxic liabilities earlier in the drug development pipeline. Two versions of the Ames were compared: the six-well (miniaturized) plate and the standard 100-mm plate test at two different laboratories. Of twenty-four chemicals tested, a subset of six chemicals was tested in the six-well test only and the remaining eighteen were evaluated in both versions of the test. The plate incorporation procedure was used with one Escherichia coli and four different Salmonella strains. The six-well test uses the same plating procedure and evaluation methods as the standard Ames assay in 100-mm plates, but the smaller format requires 20% of the test chemical. Additionally, the six-well test uses a limit concentration of 1000 µg/well versus the standard Petri plate test limit concentration of 5000 µg/plate. Testing across the two formats resulted in 100% concordance in overall mutagenicity judgement and 94% concordance across all tester strains and conditions. Known mutagenic positive control chemicals were correctly detected as positive in both formats. The overall conclusion is that the six-well assay results are concordant with the standard assay format in this evaluation and could be a reliable alternative.

Evaluation of diabetes care management in primary clinics based on the guidelines of American Diabetes Association.

OBJECTIVE: There is a rapid increase in the incidence of diabetes mellitus in Saudi Arabia. Diabetes management is an essential constituent to prevent prognosis of diabetes complications. The main objective of this study was to assess diabetes care in primary clinics based on the guidelines of American Diabetes Association (ADA). METHODS: A retrospective study at King Khaled University Hospitals, Riyadh, Saudi Arabia. A total of 200 patients were randomly selected from the databases of primary care clinics. An evaluation checklist was created based on the ADA treatment guidelines such as medical history, physical examination, laboratory evaluation, and referrals. RESULTS: The result showed that elements achieving the ADA targets for overall care were medical history (44.9%), physical examination (59.6%), laboratory evaluation (36.3%), and referrals (19.3%). The other subelement indicators such as referral to diabetes self-management education clinics (10%), dental examination (2%), HbA1c regular monitoring (33.5%), and blood pressure determination (100%) were documented with adherence to ADA standards. CONCLUSIONS: Diabetes management standards are an essential element in the success of the management plan. Most of the elements examined are not in full compliance with the ADA standard. Continues monitoring and self-review are recommended.

Laboratory Assessment of Anemia.

Anemia is one of the most common health problems in both industrialized and developing countries. It has been recognized by the World Health Organization as an important disorder leading to significant health care burden. Laboratory testing plays a significant role in the diagnosis of most types of anemia since the clinical diagnosis may not always be straightforward, especially with multiple underlying conditions. Once the existence of anemia is established, the cause must be determined to enable selection of a specific and effective therapy. Various hematologic parameters and biochemical tests can be used in combination with patient clinical history to identify the most likely causes of anemia.

Development, validation and evaluation of an analytical method for the determination of monomeric and oligomeric procyanidins in apple extracts.

There is a lack of data for individual oligomeric procyanidins in apples and apple extracts. Our aim was to develop, validate and evaluate an analytical method for the separation, identification and quantification of monomeric and oligomeric flavanols in apple extracts. To achieve this, we prepared two types of flavanol extracts from freeze-dried apples; one was an epicatechin-rich extract containing ∼30% (w/w) monomeric (-)-epicatechin which also contained oligomeric procyanidins (Extract A), the second was an oligomeric procyanidin-rich extract depleted of epicatechin (Extract B). The parameters considered for method optimisation were HPLC columns and conditions, sample heating, mass of extract and dilution volumes. The performance characteristics considered for method validation included standard linearity, method sensitivity, precision and trueness. Eight laboratories participated in the method evaluation. Chromatographic separation of the analytes was best achieved utilizing a Hilic column with a binary mobile phase consisting of acidic acetonitrile and acidic aqueous methanol. The final method showed linearity for epicatechin in the range 5-100µg/mL with a correlation co-efficient >0.999. Intra-day and inter-day precision of the analytes ranged from 2 to 6% and 2 to 13% respectively. Up to dp3, trueness of the method was >95% but decreased with increasing dp. Within laboratory precision showed RSD values <5 and 10% for monomers and oligomers, respectively. Between laboratory precision was 4 and 15% (Extract A) and 7 and 30% (Extract B) for monomers and oligomers, respectively. An analytical method for the separation, identification and quantification of procyanidins in an apple extract was developed, validated and assessed. The results of the inter-laboratory evaluation indicate that the method is reliable and reproducible.

Construction and management practice of morphologic experimental center in medical university / 中华医学教育探索杂志

Based on the construction and management practice of the morphologic experimental center in Xi'an Medical University, the achievements in laboratory daily operation and institutional man-agement were summarized in the area of lab rules and regulations, instrument and equipment, experiment teaching, lab environment and safety, lab staff administration and so on. The management work has been refined using the practice model of resource sharing, system administration, individual responsibility, and unified staff supervision. The lab rules and responsibilities were also effectively implemented on specific person. Taking the opportunity in teaching evaluation at the experimental center, the lab connotation con-struction was further strengthened. The evaluation system was thoroughly examined in order to look for gaps and promote the lab construction. Further work could be carried out on the laboratory software and hard-ware, such as instrument and equipment update, experimental teaching system reformation in morphology, promotion on multidisciplinary integration and unified management of lab staff.

Fly ash-based water dispersible powder formulation of Bacillus thuringiensis var. israelensis: Development & laboratory evaluation against mosquito immatures.

BACKGROUND & OBJECTIVES: Bacillus thuringiensis var. israelensis (Bti) formulations are presently being used for insect control. In this study, a water dispersible powder (WDP) formulation using fly ash (FA) as a carrier material was developed and studied for its activity against the larval stages of major mosquito vector species. METHODS: An indigenous isolate Bti (Vector Control Research Centre B17) was mass produced using a 100 l fermentor in soya-based medium. The bacterial biomass was mixed with lignite FA and made into WDP formulations. The most effective formulation was used for determining 50 per cent lethal concentration (LC50) against the larval stages of major mosquito vector species, effect on non-target organisms and mammalian systems using standard protocols. RESULTS: Sixteen types of WDP formulations were prepared, of which the formulation containing bacterial biomass, FA and carboxymethyl cellulose was found to be the most effective. The LC50values of the formulation against Culex quinquefasciatus, Aedes aegypti and Anopheles stephensi larvae were 0.0417, 0.0462 and 0.1091 mg/l, respectively. The formulation was found to be safe to non-target organisms found associated with the mosquito larval stages and also to mammalian systems. INTERPRETATION & CONCLUSIONS: The study shows that FA can be effectively used to replace commercially available carrier materials used in biopesticidal formulations.

Multicenter evaluation of molecular and culture-dependent diagnostics for Shigella species and Entero-invasive Escherichia coli in the Netherlands.

An inter-laboratory collaborative trial for the evaluation of diagnostics for detection and identification of Shigella species and Entero-invasive Escherichia coli (EIEC) was performed. Sixteen Medical Microbiological Laboratories (MMLs) participated. MMLs were interviewed about their diagnostic methods and a sample panel, consisting of DNA-extracts and spiked stool samples with different concentrations of Shigella flexneri, was provided to each MML. The results of the trial showed an enormous variety in culture-dependent and molecular diagnostic techniques currently used among MMLs. Despite the various molecular procedures, 15 out of 16 MMLs were able to detect Shigella species or EIEC in all the samples provided, showing that the diversity of methods has no effect on the qualitative detection of Shigella flexneri. In contrast to semi quantitative analysis, the minimum and maximum values per sample differed by approximately five threshold cycles (Ct-value) between the MMLs included in the study. This indicates that defining a uniform Ct-value cut-off for notification to health authorities is not advisable.

Neonatal haemostasis. Impact on bleeding and thrombosis.

The maturation and postnatal development of the human coagulation system results in significant and important differences in the coagulation and fibrinolysis of neonates and young children compared to older children and adults. Importantly, these differences, which mostly reflect the immaturity of the neonatal haemostasis system, are functionally balanced. Healthy neonates show no signs of easy bruising or other bleeding diathesis and no increased tendency to thrombosis for any given stimulus compared to adults. Systemic diseases may affect haemostasis, thus predisposing ill neonates to increased risk for haemorrhagic or thrombotic complications. In hospitalized children, neonates have increased risk of developing thrombosis compared to infants and children, mostly associated with the presence of central venous catheter. For diagnosis of haemostasis disorders, diagnostic laboratories processing pediatric samples should use age, analyzer and reagent appropriate reference ranges. Age specific guidelines should be followed for the management of neonates with hemostatic disorders.