Thrombosis in Children - Etiology of Congenital ThrombophilicStates

Overview

Background.
Increasing frequency of thrombosis in podiatry brings about high morbidity and mortality. Frompublished sets of clinical cases with thrombembolic complications can be concluded, that contrary to adults, originof thrombosis in children is more frequently based on congenital thrombophilic states. The main of the work is: 1. Toidentify prevalence of the congenital thrombophilic states in the set of patients with venous and arterial thrombosis.2. Formulate recommendations for the laboratory investigation. 3. Evaluate results of the thrombosis treatment inour set of patients.Methods and Results. Set of 24 patients of the average age 6.7 years at the time of thrombosis (16 time venous,8 times arterial) was retrospectively investigated for the presence of the factor V-Leiden mutation, prothrombine20210A mutation, deficiency of C and S protein, and antithrombin III. Presence of acquired risk factors was alsoevaluated. Congenital thrombophilic state was identified in 5 patients (31.2 %) with venous thrombosis and in1 patient (12.5 %) with arterial thrombosis. Mutation of the factor V-Leiden was found most frequently. It wasidentified at 3 patients (18.7 %) with venous thrombosis and 1 patient (12.5 %) with arterial thrombosis. The centralvenous catheter was the most frequent acquired risk of thrombosis (50 %). In 1 patient with venous thrombosis andin 4 patients with arterial thrombosis no acquired or congenital risks of thrombosis were identified. Results oftreatment confirmed beneficial effects of heparinisation and subsequent wafarinisation for the period of increasedrisk of thrombosis. Systemic thrombolysis was done 3 times without complications.Conclusion. Congenital thrombophilic states play significant role in the manifestations of thromboses in children.In majority of children with manifesting thrombosis at least one risk factor was identified. Cerebral infarcts in infantsremain largely unrevealed.

Key words:
thrombosis, children, S protein, C protein, antithrombin III, prothrombin, factor V-Leiden.