Thrombosis in children

What causes thrombosis in children?

The following conditions promote the development of thrombosis in newborn children:

• abnormalities of the vascular wall (for example, delayed closure of the arterial duct) and its damage (primarily by vascular catheters);
• disorders (slowing) of blood flow (for example, in infections, severe hypoxia, acidosis);
• changes in rheological properties of blood (for example, in polycythemia, severe dehydration, hypoxia, congenital deficiency of anticoagulants).

The most common causes of thrombosis in children:

• presence of vascular catheters (arterial catheters are especially dangerous);
• polycythemia;
• hyperthrombocytosis (for example, with neonatal candidiasis);
• shock and severe course of bacterial and viral infections with secondary vasculitis;
• antiphospholipid syndrome in the mother;
• hyperuricemia.

The formation of thrombosis in children occurs also in a number of hereditary thrombophilic conditions:

• deficiency and / or defects of physiological anticoagulants (antithrombin III, proteins C and B, thrombomodulin, inhibitors of the external activation pathway of coagulation, cofactor II heparin, plasminogen activator), excess protein C inhibitor and / or antithrombin III-heparin complex inhibitor;
• deficiency and / or defects of procoagulants [Factor V (Leiden), prothrombin, plasminogen, Factor XII, Prekallikrein, high-molecular kininogen], as well as thrombogenic dysfibrinogenemia;
• hyperaggregability of platelets.

Symptoms of thrombosis in children

Locus of obstruction	Symptoms
Vienna:
Lower hollow	Edema and cyanosis of the feet, often associated with kidney vein thrombi
Upper hollow	Edema of soft tissues of the head, neck, upper chest; chilothorax may occur
Kidney	Single or bilateral renomegaly; hematuria
Adrenal	Often there is a hemorrhagic necrosis of the adrenal gland with a clinic of adrenal insufficiency
Portal and liver	Usually there is no clinical symptomatology in the acute phase
Arteries:
Aorta	Congestive heart failure: difference in systolic pressure between the upper and lower limbs; decreased femoral pulse
Peripheral	Absence of palpable pulse; discoloration of the skin; skin temperature drop
Cerebral	Apnea, generalized or local convulsions, changes in neurosonography
Pulmonary	Pulmonary hypertension
The coronary	Congestive heart failure; cardiogenic shock; typical ECG changes
Kidney	Hypertension, anuria, acute renal failure
Mesenterial	Clinical signs of necrotizing enterocolitis

Diagnosis of thrombosis in children

If a child is suspected of having thrombosis, all diagnostic tools are used to determine the localization of thrombus or to exclude this pathology. Various variants of ultrasound examination, contrast angiography are used.

[1], [2], [3], [4], [5], [6]

Treatment of thrombosis in children

Treatment of thrombosis in children, proposed by different authors, is quite contradictory, since in this case, randomized studies and recommendations based on them based on evidence-based medicine are virtually impossible. First of all, correction of factors of high risk of thrombosis development is necessary. When polycythemia perform bloodletting (10-15 ml / kg), replacing the withdrawn blood with a factor of blood clotting VIII or isotonic sodium chloride solution, prescribe disaggregants (nicotinic acid or pentoxifylline, pyracetam, aminophylline, dipyridamole, etc.). If possible, remove the vascular catheters. With superficial blood clots, the skin above them is lubricated with heparin ointment (INN: Heparin sodium + Benzocaine + Benzylnicotinate). Special antithrombotic therapy is rarely used. To perform it more often used heparin sodium.

Sodium heparin, an anticoagulant that enhances the effect of antithrombin III on factor Xa and thrombin, is the drug of choice for visualized thrombi. Enter a loading dose of 75-100 U / kg body weight intravenously bolus for 10 min and then maintenance doses - 28 EDDkgrh). Against the background of heparin therapy, monitoring of the state of hemostasis is necessary. APTT (activated partial / partial thromboplastin time) should be at the upper limit of normal indices. In some cases, a surgical removal of a thrombus or body part, an organ necrotic due to impaired blood supply, is performed.