Increased thrombophilic tendency in pediatric cystic fibrosis patients.

Thrombophilia has recently been reported to be increased in patients with cystic fibrosis (CF). We wanted to determine whether this was applicable to our population with CF and how our patients compared to the previously reported groups. Seventy one pediatric CF patients were assessed for a thrombophilic tendency, using a lupus anticoagulant screen, protein C, protein S, antithrombin assay, and activated protein C resistance (APCR) screen. The incidence of activate protein C resistance (4.2%) was within expected limits for the general population as was the incidence of antithrombin deficiency. However there was a marked increase in the incidence of lupus anticoagulants (18%) and 14% and 19.7% of the patients showed a reduced protein C and protein S, respectively, far in excess of the general population. This increased incidence of thrombophilia was not related to any specific CF phenotype and while perturbed liver function cannot be entirely ruled out, it appeared unlikely to be responsible for all the abnormal coagulation findings. Despite the apparent thrombophilic tendency, no clinically evident thrombotic episodes were noted during the study period. Thrombophilia is of concern because of the increasingly frequent placement of indwelling catheters in CF patients. The precise cause for the thrombophilic tendency in CF patients is unknown at this stage.

Fibrinogen concentration and factor VIII activity in women with preeclampsia.

OBJECTIVE: To compare fibrinogen concentration and factor VIII activity obtained from pregnant women with preeclampsia with those obtained from women with either normal pregnancies or with complications unrelated to preeclampsia. MATERIALS AND METHODS: Fibrinogen concentration and factor VIII activity were measured in the following groups: normal pregnancy, consisting of women at routine 16- to 28-week antenatal visits or after admission at term for elective cesarean section; women with non-preeclampsia (non-PE) related conditions, including women with threatened abortion, cholestasis, systemic lupus erythematosus (SLE), and previous deep venous thrombosis (DVT); and women with preeclampsia as defined by the Australasion Society for the Study of Hypertension in Pregnancy (ASSHP) criteria. Blood was collected from 44 women in each group. Fibrinogen concentration and factor VIII activity were measured. RESULTS: Fibrinogen concentrations and factor VIII activities were higher in women with preeclampsia compared with those from women with either normal or complicated pregnancies (p < 0.05). It was twice as likely that a woman with preeclampsia would have a raised fibrinogen and factor VIII levels. The ranges for each analyte did, however, show overlap. Women with preeclampsia were more likely to have both a raised fibrinogen concentration and increased factor VIII activity than other pregnant women (p < 0.001). CONCLUSION: This study has shown a novel increase in both fibrinogen concentration and factor VIII activity in pregnant women with preeclampsia compared with values obtained from women with normal or non-preeclampsia complicated pregnancies, with women with preeclampsia twice as likely to have a raised fibrinogen concentration and increased factor VIII activity. These changes may contribute to the hypercoagulability seen in preeclampsia.

Acceptability of CoaguChek S and CoaguChek XS generated international normalised ratios against a laboratory standard in a paediatric setting.

AIMS: Point of care (POC) testing is convenient for both patients and physicians but the accuracy of the results must be guaranteed. In this study we evaluated the accuracy of the international normalised ratios (INR) generated from the CoaguChek S and the newer CoaguChek XS against our laboratory standard. METHODS: The INR values obtained from 87 tests on the CoaguChek S and 97 tests on the CoaguChek XS were compared with those generated from a laboratory based coagulation analyser. The results were statistically analysed. RESULTS: The values from the CoaguChek XS were closer to the laboratory based results than those from the CoaguChek S but were still significantly different (p<0.001). Using an arbitrary INR difference of