CHILDHOOD THROMBOSIS

Objective. The objective of our study was to evaluate the age, sex, cl inical conditions, family history, site, catheter association, means o f radiologic evaluation, development of pulmonary involvement, prevale nce of antithrombin III, protein C and protein S deficiencies, and lup us anticoagulants in children who suffered a thrombotic event. Methods . Data were collected on children over 1 month of age who had or devel oped a thrombotic event from 1987 through 1993 at two pediatric center s. Results. Sixty-one children (mean age, 10 years) suffered a thrombo tic event. Males and females were equally affected A variety of clinic al prothrombotic conditions similar to those described in adults could be identified for two thirds of the children. Family history was posi tive in seven children. The primary thrombotic site for two thirds of the children was the central nervous system and other centrally locate d blood vessels. Diagnosis of the primary thrombotic site was primaril y by ultrasound. A central vascular access device was associated with 25% of thromboses. Lung involvement occurred in 20%. Two thirds of the children were evaluated for a lupus anticoagulant and a deficiency of protein C and protein S; two thirds had one of these diagnosed. For f urther analyses, children without an underlying prothrombotic systemic illness or precipitant at the time of thrombosis (n = 20) were compar ed to those with these conditions (n = 41). Central nervous system thr omboses were significantly increased in the children without prothromb otic conditions. The prevalence of a deficiency of protein C or protei n S or the presence of a lupus anticoagulant approached 90% in the gro up without prothrombotic conditions as compared with 50% in the other group. Conclusion. We conclude that prospective multicenter pediatric thrombosis studies are warranted to confirm our preliminary findings o f a high incidence of lupus anticoagulants and protein C and protein S deficiency in children with thromboses.