Relationship between serum bilirubin and coagulation test results in 1-month-old infants
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《美国医学杂志》
Department of Pediatrics, GATA Haydarpasa Teaching Hospital, Tibbiye Cd. 34668-Uskudar Istanbul, Turkey
I want to add a short notation to an article named "Relationship between Serum Bilirubin and Coagulation Test Results in 1-month-old Infants. It was published in 2005 March issue of the Indian Journal of Pediatrics .[1]
The paper was a study on whether there is a positive correlation between bilirubin levels and PT and APTT results in 1-month-old infants. The ALT, AST, PT, and INR tests had been performed to find out this correlation. A significant positive correlation had been found between bilirubin levels and PT and APTT results in the study and it has been defined by some degree of vitamin K deficiency due to mild cholestasis. I agree with the authors that cholestasis may be the cause of elevated levels of PT and APTT but none of the tests they used in the study could help us on assesing cholestasis. There are two simple tests related with cholestasis: gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase. GGT is present in intra and extrahepatic bile ductular cells and in hepatocytes, and it is a sensitive but not a specific indicator of hepatic disease. GGT is frequently increased in acute hepatitis and also in cholestasis.[2] Alkaline phosphatase is present in several tissues including the liver canalicular membrane. In neonates, growth and bone activity make interpretation of increased serum alkaline phosphatase concentrations problematic. The serum gamma glutamyltransferase (GGT) value may be useful in such a case.[3] Therefore, GGT analysis should have been added to study.
References
1. Filiz T, Berkan G, Aylin T. Relationship between serum bilirubin and coagulation test results in 1-month-old infants. Indian J Pediatr 2005; 72 : 205-207.
2. Maggiore G, Bernard O, Hadchouel M et al. Diagnostic value of serum gamma-glutamyl transpeptidase activity in liver diseases in children. J Pediatr Gastroenterol Nutr 1991; 12 : 21-26.
3. Rosenthal P. Assessing liver function and hyperbilirubinemia in the newborn. Clinical Chemistry 1997; 43: 228-234.(Aydinoz Secil)
I want to add a short notation to an article named "Relationship between Serum Bilirubin and Coagulation Test Results in 1-month-old Infants. It was published in 2005 March issue of the Indian Journal of Pediatrics .[1]
The paper was a study on whether there is a positive correlation between bilirubin levels and PT and APTT results in 1-month-old infants. The ALT, AST, PT, and INR tests had been performed to find out this correlation. A significant positive correlation had been found between bilirubin levels and PT and APTT results in the study and it has been defined by some degree of vitamin K deficiency due to mild cholestasis. I agree with the authors that cholestasis may be the cause of elevated levels of PT and APTT but none of the tests they used in the study could help us on assesing cholestasis. There are two simple tests related with cholestasis: gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase. GGT is present in intra and extrahepatic bile ductular cells and in hepatocytes, and it is a sensitive but not a specific indicator of hepatic disease. GGT is frequently increased in acute hepatitis and also in cholestasis.[2] Alkaline phosphatase is present in several tissues including the liver canalicular membrane. In neonates, growth and bone activity make interpretation of increased serum alkaline phosphatase concentrations problematic. The serum gamma glutamyltransferase (GGT) value may be useful in such a case.[3] Therefore, GGT analysis should have been added to study.
References
1. Filiz T, Berkan G, Aylin T. Relationship between serum bilirubin and coagulation test results in 1-month-old infants. Indian J Pediatr 2005; 72 : 205-207.
2. Maggiore G, Bernard O, Hadchouel M et al. Diagnostic value of serum gamma-glutamyl transpeptidase activity in liver diseases in children. J Pediatr Gastroenterol Nutr 1991; 12 : 21-26.
3. Rosenthal P. Assessing liver function and hyperbilirubinemia in the newborn. Clinical Chemistry 1997; 43: 228-234.(Aydinoz Secil)