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Coagulation profiles and viscoelastic testing in multisystem inflammatory syndrome in children

Ashish A Ankola1, Victoria R Bradford2, Jane W Newburger3

  • 1Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

Pediatric Blood & Cancer
|September 17, 2021
PubMed

Insights

Children with multisystem inflammatory syndrome (MIS-C) show hypercoagulability on thromboelastography (TEG) testing, indicating increased clot strength. Inflammatory markers like ESR and platelets correlate with clot strength, suggesting potential for thromboprophylaxis strategies.

Area of Science:

  • Pediatric critical care medicine
  • Hematology
  • Rheumatology

Background:

  • Multisystem inflammatory syndrome in children (MIS-C) is a serious condition associated with hyperinflammation and potential thrombotic complications.
  • Understanding the hemostatic profile of MIS-C is crucial for guiding clinical management and preventing adverse events.

Purpose of the Study:

  • To characterize the viscoelastic testing profiles of children diagnosed with MIS-C.
  • To investigate the relationship between thromboelastography (TEG) parameters and inflammatory markers in MIS-C patients.

Main Methods:

  • A single-center retrospective review of 30 MIS-C patients (March-September 2020).
  • Thromboelastography (TEG) with platelet mapping performed in 19 patients and compared to age- and sex-matched controls.
  • Correlation analysis between TEG parameters and inflammatory markers (ESR, platelet counts).

Main Results:

  • MIS-C patients exhibited abnormal TEG results indicative of hypercoagulability, including increased clot formation rate and strength, and reduced fibrinolysis compared to controls.
  • TEG maximum amplitude and alpha angle showed moderate correlations with erythrocyte sedimentation rate (ESR) and platelet counts.
  • Prophylactic treatment with aspirin (ASA) and/or anticoagulation was administered to most patients, with no symptomatic thrombotic events or major bleeding observed.

Conclusions:

  • Viscoelastic testing via TEG reveals evidence of hypercoagulability in children with MIS-C.
  • Elevated ESR and platelet counts are associated with increased clot strength in these patients.
  • Further multicenter studies are needed to establish optimal thromboprophylaxis algorithms for MIS-C.
Abstract

Keywords:
COVID-19MIS-Cthromboelastographythrombosis

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