Thrombotic complications in pediatric patients

Posted by e-Medical PPT Monday, March 5, 2012
Thrombotic events in children
Presentation may be more extensive
Over 50% of events: in upper venous system, secondary to central venous lines (CVLs)
More unusual locations
Essentially in all children: severe underlying disorders.
Different underlying pathology (for example, Congenital Heart Disease)
Patients with homozygous Protein S or Protein C deficiency present at birth with purpura fulminans, entity essentially unknown in adult population.
Hemostatic system of the young differs from the adult.

Incidence of thrombotic complications in children appear to be increasing
Unlike venous thromboembolism in adults, VTE in children is usually a complication of a primary illness or therapy.
As survival rates for major childhood illnesses such as CHD and cancer improve, the incidence of VTE is increasing dramatically.

Central Venous lines
Upper limb DVT more frequently associated with CVLs.
Long term parenteral nutrition using CVL: high risk situation
Gold standard for diagnosis: venography
CVL’s predispose to thrombosis by introducing foreign surface, damaging the endothelium, disturbing blood flow, content of fluid infusions)
Leading cause of thromboembolic disease in children.
Incidence underestimated, perhaps because of different diagnostic modalities.

Can lead  to repeat anesthesia for CVL replacement
Lethal Pulmonary embolism
Superior Vena Cava Syndrome
Postphlebitic syndrome
Recurrent thrombosis
Side effects of long-term anticoagulants

Right atrial thrombosis
Children tend to be young

CVL’s present in over 80% of cases
Most common underlying disease: CHD
Patients may be asymptomatic
Diagnosis: on routine echocardiography or present with CVL malfunction, sepsis, CHF

Paradoxical emboli
VTE can also present as stroke with paradoxical emboli (in children with right-to-left shunt)

Cerebral vein thrombosis
Largest group of affected children:Newborns within 1st month of life
Most common symptoms: headache, seizures, lethargy, intermittent hyper-excitability.
Most common underlying disorders: Cardiac disease, thrombophilia
Diagnostic test of choice: MRI / MRV.

Kawasaki’s disease
Arterial catheters
Takayasu’s arteritis
Arterial occlusion of transplanted organs
CNS arterial thromboembolic events

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