کزین برتر اندیشه بر نگذرد بنام خداوند جان و خرد کزین برتر اندیشه بر نگذرد

IRAN UNIVERSITY OF MEDICAL SCIENCE NEONATAL HEMATOLOGY CONGRESS Dr FARHAD CHOOBDAR NEONATALOGIST IRAN UNIVERSITY OF MEDICAL SCIENCE NEONATAL HEMATOLOGY CONGRESS

APPROACH TO NEONATAL THROMBOSIS

OBJECTIVEo Understand why neonate may be at increase risk for THROMBOSIS How to evaluate THROMBOPHILIA

THROMBOPHILIA INHERITED ACQUIRED ANTI-THROMBIN. def PROTEIN C&S .def FACTOR-V LEIDEN. Mut PROTHROMBIN G20210.mut DYSFIBRINOGENEMIA HYPERHOMOCYSTEINEMIA (MTHFR.mut) ELEVATED FACTOR VIII ELEVATED LIPOPROTEIN A PAI-1 POLYMORPHISM ANTI PHOSPHOLIPID Ab .ACL Ab .ANTI β-2 GLYCOPROTEIN .ANTI-LA MAJOR MEDICAL CONDITION .INFLAMMATION .↑ CONSUMPTION .INVASIVE PROCEDURES

W/U & LAB TEST D-dimer .breakdown of fibrin .physiologically ↑ up to 1th 3day .sensitivity %96 .not specific .NPV : %93-96

THROMBOPHILIA PANEL Factor V Laden Anti-Thrombin III Assay Prothrombin Gene Mutation Protein C & S Level Homocystein Factor VIII Level Anti-Phospholipid Ab

INDICATION Any unprovoked DVT Recurrent provoked DVT Highly Recommended Any unprovoked DVT Recurrent provoked DVT Despite adequate prophylaxis DVT requiring catheter directed thrombolysis

INDICATION Suggested CNS thrombosis Asymptomatic newborns with + F.Hx Arterial thrombosis Recurrence of DVT with shorter duration of therapy(↓ 6 weeks)

INDICATION Not Recommended Clinically asymptomatic thrombosis Just radiographically detected

Prior to initiating Heparin Timing of sampling Prior to initiating Heparin D-dimer Anti-thrombin III Assay Factor VIII Level Lupus Anticoagulant

Prior to initiating Warfarin Timing of sampling Prior to initiating Warfarin Lupus Anticoagulant Protein C Protein S L

IMAGING Ultrasound Non invasive Diagnosis Lack of compression Lack of waveform response with respiration Echogenecity inside lumen

Imaging-Ultrasonography Lower. ext Upper.ext 95% sensitivity for proximal 50% for Calf limited ability to see iliac veins Sensitivity 54-100% Specificity 94-100% Technical difficulty

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