Pendekatan diagnosis perdarahan neonatus harus dilakukan seperti halnya pemeriksaan klinis yang baku. Anamnesis yang lengkap harus meliputi anamnesis neonatus, riwayat maternal, dan riwayat keluarga. Riwayat kehamilan dan persalinan sebelumnya dapat menjadi petunjuk penting dalam diagnosis NAIT. Riwayat penyakit ibu seperti immune thrombocytopenia atau lupus eritematosus sistemik, serta obat yang dikonsumsi ibu perlu ditanyakan.13
Riwayat keluarga sangat penting dalam mendeteksi kemungkinan kelainan perdarahan herediter. Adanya riwayat hemofilia pada keluarga sangat membantu diagnosis. Riwayat konsanguinitas merupakan risiko terjadinya kelainan
Tabel 2. Pola skrining koagulasi neonatus.8,13
Condition PTT PT Fibrinogen D-Dimer Platelet
Count
PFA-100
Well term infant Normal to Normal
to Normal Negative
to Normal
Well preterm infant Normal to
Normal
to Normal Negative
to Normal Normal to
Hemophilia A or B Normal Normal Negative
to Normal Normal to
Severe von Willebrand disease
Normal Normal Negative
to Normal to
Thrombocytopenia Normal to Normal Normal Negative
to to to
Platelet dysfunction Normal to Normal Normal Negative
to Normal to to
Heparin contamination to Normal to
Normal Negative
to Normal Normal to
Vitamin K defi ciency to to Normal Negative
to Normal Normal to
Sepsis to to Normal to to to to
Hypoxia to Normal to
Normal to to to Normal to
Liver failure to to Normal to to to to
Disseminated intravascular coagulation
to to Normal to to to to
perdarahan yang diturunkan secara autosomal recessive. Namun tidak adanya riwayat keluarga tidak serta-merta menyingkirkan diagnosis kelainan perdarahan herediter. Sebagai contoh adalah sekitar 30% pasien hemofilia ternyata tidak memiliki riwayat keluarga.6,20
Pemeriksaan laboratorium hemostasis pada neonatus perlu mendapat perhatian karena karakteristik yang berbeda dengan dewasa (Tabel 2).
Pemeriksaan awal skrining hemostasis adalah pemeriksaan jumlah trombosit, PT dan aPTT. Apabila jumlah trombosit normal, dilakukan analisis berdasarkan nilai PT dan aPTT, tentunya dengan mengikutsertakan data klinis lain seperti yang sudah dijelaskan sebelumnya (Gambar 7). Pemanjangan PT mencerminkan adanya penurunan faktor koagulasi yang tergantung vitamin K, sedangkan pemanjangan aPTT mencerminkan penurunan konsentrasi faktor kontak plasma.1,6,10
Gambar 7. Algoritma diagnos k pada neonatus dengan perdarahan dan jumlah trombosit normal.2
PT
Periksa:
FVII
aPTT aPTT
Periksa:
FX FV FII Fibrinogen
Periksa:
FXIII Ȱ2Ͳantiplasmin Fungsitrombosit Periksa:
HMWK Prekallikrein
FXII FIX FXI FVIII VonWillebrand
memanjang memanjang
memanjang
normal
normal
normal
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