Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth?

ABSTRACT BACKGROUND Phlebotomy is among the main determinants of anemia of prematurity. Blood sparing policies endorsed umbilical cord blood (here called placental) as an alternative source for laboratory testing. Little is known on the suitability of placental blood to evaluate neonatal hemostasis of newborn infants. We aimed to compare the hemostatic profile of paired placental and infant venous blood, by means of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, protein C, thromboelastography (TEG) and thrombin generation assay (TGA). STUDY DESIGN This was an observational single‐center study. METHODS We collected at birth venous citrated blood from both placental and infant venous source and performed PT, APTT, fibrinogen, antithrombin, protein C, TEG (reaction time‐R; kinetics‐K alpha angle‐α, maximum amplitude‐MA and lysis at 30 minutes‐LY30), and TGA (endogenous thrombin potential‐ETP). RESULTS We enrolled 60 neonates with a median gestational age (range) of 37 weeks (28+1‐41) and birth‐weight 2417 g (950‐4170). Based on TEG and TGA, placental blood showed a procoagulant imbalance as indicated by lower median R (4.0 vs. 6.1 min; p