THROMBOEMBOLISMS IN THAI PEDIATRIC PATIENTS: A REPORT OF 100 EPISODES

Chuansumrit A, Chiemchanya S, Khowsathit P, Supapanachart S, Hongeng S, Hathirat P

Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Objective: To analyze the etiology, management and outcome of Thai pediatric patients with thromboembolism.

Methods: A retrospective study of patients admitted at the Department of Pediatric, Ramathibodi Hospital from 1987 to 2000, was conducted.

Results: Total 86 patients with 100 thromboembolisms were enrolled in the study. The sites of thromboembolism were in the venous sinus or arteries of the central nervous system 27%; the skin with necrosis, 23%; deep vein of the extremities, 17%; the toes and fingers with gangrene, 14%; and other sites such as the heart and lugs, 19%. Most of the patients had triggering conditions (69%) including endothelial injury, stasis of blood and alteration of coagulation factors. Factor V Leiden and prothrombin 20210 were not found among 20 studied patients; however, low levels of antithrombin III, protein C or protein S were found in 39% (22/57) of the patients. Most of these were transient except for three who were diagnosed with homozygous (n=2) and heterozygous (n=1) protein C deficiency. The management included administration of standard heparin or low molecular weight heparin, if not contraindicated replacement of fresh frozen plasma 10 ml/kg twice a day and treatment of triggering and underlying conditions. The fatality rate was 14% (12/86). Subsequent episodes of thromboembolism were found in 8 patients who did not receive appropriate management.

Conclusion: Comprehensive investigation and specific treatment for pediatric patients are emphasized in order to prevent recurring thromboembolic episodes.

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