Vitamin K-Dependent Coagulation Factor Levels in the Cord Blood of Full-Term and Premature Infants: An Establishment of Normal Reference Values and Comparison of Factor Levels Between Term and Preterm Infants
Halasz, Susan Patricia
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It has been shown that significantly lower amounts of Vitamin K-dependent coagulation factors (Factors II, IX, X, Protein C, and total and free Protein S) are found in newborns as compared to adults. This study was designed to determine normal reference values of the amounts of these Vitamin K dependent coagulation proteins in healthy term and preterm infants and to conduct a comparison of these values between the two groups. Plasma samples were obtained from 25 premature and 45 full-term infants and subjected to immunoelectrophoresis and biological activity assays. In comparing the means of the antigen levels of each of the SIX factors in the term group to the corresponding means in the preterm group, no significant difference for Factor X or total Protein S was found. However, antigen levels of Factor II, Factor IX, and Protein C were found to be significantly lower in the preterm group than in the full-term group with P< 0.001 for all three. In addition, free Protein S was found in significantly higher levels in the preterm than in the term group with P< 0.001. Yet, despite these results no direct correlation was found between factor levels and gestational age, r< 0.10 for all Vitamin K-dependent factors studied in the premature infants. The results of this study suggest that partial liver immaturity and a natural selective maturation pattern of the coagulation system may allow for the variation of the amounts of Factors II, IX, X, and Protein C found in premature and full-term infants. The levels of Protein S found may be due to the fact that Protein S is synthesized in the vascular endothelium.
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