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Prothrombotic abnormalities in children with venous thromboembolism
M Bonduel1, M Hepner, G Sciuccati
1Hematology-Oncology Department, Hospital de Pediatría, Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
Insights
A high frequency of prothrombotic disorders was found in children with venous thromboembolism (VTE). A complete hemostatic evaluation is recommended for all pediatric VTE patients to identify inherited or acquired conditions.
Area of Science:
- Pediatric Hematology
- Thrombosis Research
- Vascular Medicine
Background:
- Venous thromboembolism (VTE) in children is a significant clinical concern.
- Identifying underlying prothrombotic disorders is crucial for management and prevention.
Purpose of the Study:
- To determine the prevalence of acquired and inherited prothrombotic disorders in pediatric patients diagnosed with VTE.
- To assess the frequency of these disorders in relation to identified risk factors.
Main Methods:
- Prospective study of 56 consecutive pediatric patients with VTE over a six-year period (1992-1998).
- Evaluation included assessment of risk factors, family history, and specific laboratory testing for prothrombotic conditions.
Main Results:
- A high rate of risk factors (96%) and prothrombotic disorders (46%) was observed in the pediatric VTE cohort.
- Commonly detected inherited disorders included protein C deficiency, protein S deficiency, and Factor V Leiden mutation.
- Acquired disorders such as antiphospholipid antibodies and antithrombin deficiency were also frequently identified.
Conclusions:
- A substantial proportion of children with VTE have underlying prothrombotic disorders, both inherited and acquired.
- Comprehensive hemostatic evaluation is essential for all pediatric VTE cases, irrespective of the presence of other risk factors.
Purpose:
The aim of this study was to determine the frequency of acquired or inherited prothrombotic disorders in a pediatric population with venous thromboembolism (VTE).
Patients And Methods:
From May 1992 to April 1998, 56 consecutive children with VTE were prospectively studied at a single center.
Results:
The median age was 8.4 years (range, 0.1-18 years). There was a male predominance. Fifty (89%) children had thrombosis in the lower venous system. Risk factors were detected in 54 (96%) children. Twenty-one (38%) thrombotic episodes were related to central venous lines. Family history of thrombosis was positive in 13 (23%) patients. In 26 (46%) patients, a prothrombotic disorder was detected. Nine of them had inherited disorders (protein C deficiency, 5 patients; protein S deficiency, 3 patients; Factor V Leiden mutation, 1 patient), and 13 children had acquired disorders (antiphospholipid antibodies, 5 patients; antithrombin deficiency, 8 patients). The remaining four showed combined abnormalities (Factor V Leiden mutation associated with inherited protein S deficiency, 1 patient; acquired antithrombin deficiency, 2 patients and inherited antithrombin deficiency, 1 patient).
Conclusions:
In the series, a high percentage of prothrombotic disorders was detected; thus, a complete hemostatic evaluation should be performed in all of the children with VTE whether the patients have one or more risk factors.