The importance of incidentally detected coagulation abnormalities in children

A history and physical examination can predict most bleeding disorders. This study aimed to reveal possible hemostatic disorders in patients referred to the pediatric hematology department due to the incidentally detected prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT). Pediatric patients without known hematologic disease and referred to investigate the incidental prolonged PT and/or aPTT were included. Coagulation factor activities were analyzed in these patients; antiphospholipid antibodies and lupus anticoagulant tests were studied in patients with abnormal mixing results. A total of 103 patients were included in the study, but in re-evaluation, fifty-three children repeated tests were normal. Further examinations were done for 50 children whose PT/aPTT abnormality persisted in repeated tests. Seventeen patients presented with isolated prolonged PT, twenty-seven patients presented with isolated prolonged aPTT, and six patients with both prolonged PT and aPTT. Coagulopathy was found in 31 (30%) of the whole cohort, which was 60% of patients with persistent abnormal tests. The most common deficient factors were FXII (5.8%), FXI (4.8%), FVII (2.9%), FV (0.9%), FVIII (0.9%), fibrinogen with FVII deficiency (0.9%), and von Willebrand factor (vWF) deficiency (0.9%). According to the results of our study in patients presenting with incidental PT and/or aPTT prolongation, mild factor deficiencies are more common than expected. Mild coagulation factor deficiencies can be seen in patients without any bleeding history. There is often no evidence of bleeding in mild factor deficiencies, and their clinical significance is unknown.