Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(1) > 1043474

Korean J Pediatr Gastroenterol Nutr. 2010 Mar;13(1):23-29. Korean.
Published online March 31, 2010.  https://doi.org/10.5223/kjpgn.2010.13.1.23
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Clinical Significance of Coagulation Screening Tests and Platelet Counts in Children Undergoing Endoscopy
Eun Hye Lee, M.D., Hye Ran Yang, M.D., Jae Sung Ko, M.D. and Jeong Kee Seo, M.D.
Division of Gastroenterology and Nutrition, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author (Email: hryang@snubh.org )
Received February 09, 2010; Accepted March 07, 2010.

Abstract

Purpose

The aim of this study was to assess the benefits of routine pre-endoscopy coagulation screening tests and platelet counts in Korean children.

Methods

Between March 2004 and December 2009, children who underwent gastrointestinal endoscopy for the evaluation of various gastrointestinal symptoms were included. All of the subjects included in the study also underwent routine coagulation screening and platelet count determinations prior to endoscopy and biopsy. The clinical records and laboratory tests were retrospectively reviewed in all patients.

Results

One hundred sixty-two of 1,476 (11%) patients who underwent endoscopy had abnormal results on pre-screening coagulation tests. Fourteen patients underwent coagulation factor assays due to abnormal clotting results in consecutive tests or due to clinical evidence of a bleeding tendency. Seven patients were diagnosed with factor XII deficiency, one patient was diagnosed with von Willebrand disease, one patient had von Willebrand disease and factor XII deficiency, and one patient was presumed to have mild hemophilia. The remaining 4 patients had normal results with the factor assays. The results of platelet counts were normal with the exception of 1 patient. No patient had significant bleeding during the endoscopic procedures, despite abnormal pre-endoscopic coagulation tests.

Conclusion

Routine coagulation screening tests and platelet counts revealed abnormal results in some patients. Most of the patients with abnormal clotting were shown to have a factor XII deficiency, which had no significant associated bleeding tendencies; the other patients were diagnosed with hemophilia or von Willebrand disease. Therefore, although abnormal pre-endoscopic coagulation is not always related to significant bleeding complications, pre-endoscopic coagulation screening may be useful in some children in predicting the risk of bleeding tendency during endoscopic procedures.

Keywords: Gastrointestinal endoscopy; Coagulation test; Platelet count; Factor deficiency; Children

Tables


Table 1
Abnormal Results of Pre-endoscopic Coagulation Screening Tests
Click for larger image


Table 2
Results of Factor Assays
Click for larger image

References
1. Levy MJ, Anderson MA, Baron TH, Banerjee S, Dominitz JA, Gan SI, et al. Position statement on routine laboratory testing before endoscopic procedures. Gastrointest Endosc 2008;68:827–832.
2. Escuriola Ettingshausen CE, Halimeh S, Kurnik K, Schobess R, Wermes C, Junker R, et al. Symptomatic onset of severe hemophilia A in childhood is dependent on the presence of prothrombotic risk factors. Thromb Haemost 2001;85:218–220.
3. Ljung R, Petrini P, Nilsson IM. Diagnostic symptoms of severe and moderate haemophilia A and B a survey of 140 cases. Acta paediatrica 1990;79:196–200.
4. Pollmann H, Richter H, Ringkamp H, Jurgens H. When are children diagnosed as having severe haemophilia and when do they start to bleed? A 10-year single-centre PUP study. Eur J Pediatr 1999;158:166–170.
5. Kitchens CS. Occult hemophilia. Johns Hopkins Med J 1980;146:255–259.
6. Venkateswaran L, Wilimas JA, Jones DJ, Nuss R. Mild hemophilia in children: prevalence, complications and treatment. J Pediatr Hematol Oncol 1998;20:32.
7. Van Os EC, Kamath PS, Gostout CJ, Heit JA. Gastroenterological procedures among patients with disorders of hemostasis: evaluation and management recommendations. Gastrointest Endosc 1999;50:536–543.
8. Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L. Maturation of the hemostatic system during childhood. Blood 1992;80:1998–2005.
9. Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, et al. Development of the human coagulation system in the full-term infant. Blood 1987;70:165–172.
10. Dzik WH. Predicting hemorrhage using preoperative coagulation screening assays. Curr Hematol Rep 2004;3:324–330.
11. Suchman AI, Mushlin AI. How well does the activated partial thromboplastin time predict postoperative hemorrhage? JAMA 1986;256:750–753.
12. Rohrer MJ, Michelotti MC, Nahrwold DL. A prospective evaluation of the efficacy of preoperative coagulation testing. Ann Surg 1988;208:554–557.
13. Perez A, Planell J, Bacardaz C, Hounie A, Franci J, Brotons C, et al. Value of routine preoperative tests: a multicentre study in four general hospitals. Br J Anaesth 1995;74:250–256.
14. Smetana GW, Macpherson DS. The case against routine preoperative laboratory testing. Med Clin North Am 2003;87:7–40.
15. Giles E, Walton-Salih E, Shah N, Hinds R. Routine coagulation screening in children undergoing gastrointestinal endoscopy does not predict those at risk of bleeding. Endoscopy 2006;38:508–510.
16. Burk CD, Miller L, Handler SD, Cohen AR. Preoperative history and coagulation screening in children undergoing tonsillectomy. Pediatrics 1992;89:691–695.
17. Lowe GD, Forbes CD. Laboratory diagnosis of congenital coagulation defects. Clin Haematol 1979;8:79–94.
18. Dzankic S, Pastor D, Gonzalez C, Leung JM. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg 2001;93:301–308.
19. Yong DE, Lew SH, Lee JW, Park QE. A case of severe factror XII defiency. Korean J Thromb Hemost 1996;3:145–151.
20. Stavrou E, Schmaier AH. Factor XII: What does it contribute to our understanding of the physiology and pathophysiology of hemostasis & thrombosis. Thrombosis Research 2010;125:210–215.
21. Mannhalter C, Fischer M, Hopmeier P, Deutsch E. Factor XII activity and antigen concentrations in patients suffering from recurrent thrombosis. Fibrinolysis 1987;1:259–263.
22. Nam YS, Kim NK, Lee SM, Kang MS, Oh DY, Cha KY. A study of factor XII defiency in recurrent spontaneous abortion. Korean Journal of Fertility and Sterility 2001;28:209–213.
23. Nam YS, Kim IH, Yoon TK, Lee CN, Cha KY. A case of factor XII defiency which was found in recurrent spontaneous abrtion. Korean Journal of Fertility and Sterility 1999;26:271–274.
24. Gordon EM, Donaldson VH, Saito H, Su E, Ratnoff OD. Reduced titers of Hageman factor (factor XII) in Orientals. Ann Intern Med 1981;95:697–700.
25. Cho YU, Chi HS, Choi SJ, Sim EH, Park CJ. The 46C/T polymorphism of coagulation factor XII in healthy Korean population and in patient with ischemic cerebrovascular disease. Korean J Lab Med 2002;22:224–231.
26. Halbmayer WM, Haushofer A, Schon R, Mannhalter C, Strohmer E, Baumgarten K, et al. The prevalence of moderate and severe Fxii (Hageman-Factor) deficiency among the normal population - evaluation of the incidence of Fxii deficiency among 300 healthy blood-donors. Thromb Haemost 1994;71:68–72.
27. Barthels M, Edel J, Liese B, Karges HE. Additional factor XII (Hageman factor) deficiency in hemophilia A and in von Willebrand syndrome. Klin Wochenschr 1982;60:303–309.
28. Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand's disease. Blood 1987;69:454–459.
29. Sadler JE, Mannucci PM, Berntorp E, Bochkov N, Boulyjenkov V, Ginsburg D, et al. Impact, diagnosis and treatment of von Willebrand disease. Thromb Haemost 2000;84:160–174.