Thrombelastography for the monitoring of lipopolysaccharide induced activation of coagulation in neonatal cord and adult blood

The haemostatic system of neonates is quantitatively deficient at birth, and many coagulation variables constantly change over the first months of life. During Gram-negative sepsis, lipopolysaccharide (LPS) activates toll-like receptor (TLR) 4 and induces complex responses of immune system and haemostasis. Method: In the present study we compared LPS-induced activation of coagulation in whole blood (WB) samples from healthy adult volunteers and neonatal cord blood. Samples were incubated with LPS or control vehicle (normal saline) for various incubation periods (0–2-3–4 hrs), and coagulation was measured by rotation thrombelastography (Roteg 5, Pentapharm, Munich, Germany), a modification of the original thrombelastography method. The following four standard variables were analyzed: clotting time (CT), clot formation time (CFT), maximal clot formation (MCF), and angle a. Results: In the absence of LPS, CTs and CFTs were significantly shorter in cord than in adult WB samples (572±99 vs. 767±108s, and 225±50 vs. 393±57s). The time course of the LPS-induced interaction in thrombelastography parameters of adult WB and cord WB demonstrates that all parameters (CT, CFT, MCF, and angle a) were affected as the incubation period with LPS (100ng/ml) increased. Reduction of CT due to LPS incubation was significantly higher in cord (81 +/- 5%) than in adult WB samples (70 +/- 8%). Conclusion: In the present study we found in accordance with the clinical experience, a high procoagulant readiness of cord versus adult WB. CTs were significantly shorter in native cord versus adult WB as evaluated by means of TEG. Moreover, shortening of CTs was significantly more pronounced in cord versus adult WB when samples were incubated with LPS indicating a higher sensitivity for coagulopathy in septic neonates. In summary, thrombelastography proved to be a sensitive and reliable tool for the determination of LPS-induced activation of haemostasis in whole blood samples from adults and neonates.