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کزین برتر اندیشه بر نگذرد

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Presentation on theme: "کزین برتر اندیشه بر نگذرد"— Presentation transcript:

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

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

3 APPROACH TO NEONATAL THROMBOSIS

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

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17 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

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

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

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

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

22 INDICATION Not Recommended
Clinically asymptomatic thrombosis Just radiographically detected

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

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

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

26 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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