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Thrombophilia screening and thromboprophylaxis may benefit specific ethnic subgroups with paediatric acute

Shlomit Barzilai-Birenboim1, Nira Arad-Cohen2, Ronit Nirel3

  • 1Department of Paediatric Haematology and Oncology, Schneider Children's Medical Centre of Israel, Petach Tivka, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

British Journal of Haematology
|January 12, 2019
PubMed

Insights

Inherited thrombophilia is common in Israeli children with acute lymphoblastic leukaemia (ALL), increasing venous thromboembolism (VTE) risk. Prophylaxis with low molecular weight heparin in thrombophilic children with ALL prevented severe VTE.

Area of Science:

  • Hematology
  • Pediatric Oncology
  • Genetics

Background:

  • Inherited thrombophilia is a known risk factor for venous thromboembolism (VTE).
  • Acute lymphoblastic leukaemia (ALL) treatment can increase VTE risk in children.
  • Understanding thrombophilia prevalence is crucial for VTE prevention in pediatric ALL patients.

Purpose of the Study:

  • To investigate the prevalence of inherited thrombophilia in Israeli children with ALL.
  • To assess the risk of VTE associated with thrombophilia in this cohort.
  • To evaluate the benefit of low molecular weight heparin (LMWH) prophylaxis.

Main Methods:

  • Retrospective analysis of 476 Israeli children diagnosed with ALL between 2004 and 2016.
  • Screening for inherited thrombophilia markers.
  • Comparison of VTE rates between thrombophilic and non-thrombophilic patients.
  • Assessment of severe VTE incidence in patients receiving LMWH prophylaxis.

Main Results:

  • 15.5% of children with ALL had inherited thrombophilia.
  • Arab children showed a significantly higher prevalence of F5 R506Q (factor V Leiden) mutation compared to Jewish children (19.4% vs. 2.9%, P < 0.01).
  • Patients with thrombophilia had a substantially higher risk of VTE (26.5% vs. 5.6%, P < 0.001).
  • No severe VTE events were observed in thrombophilic children who received LMWH prophylaxis.

Conclusions:

  • Routine screening for inherited thrombophilia in children with ALL is warranted.
  • Thromboprophylaxis with LMWH in identified high-risk patients can effectively prevent severe VTE.
  • This strategy may improve outcomes for pediatric ALL patients at risk for VTE.

Keywords:
factor V Leidenpaediatric acute lymphoblastic leukaemiaprophylactic low molecular weight heparinthrombophiliavenous thromboembolism

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