Clinical and laboratory characteristics of children with venous thromboembolism and protein C‐deficiency: an observational Israeli‐German cohort study

• Published in: British journal of haematology Vol. 167; no. 3; pp. 385 - 393
• Main Authors: Limperger, Verena, Klostermeier, Ulrich C., Kenet, Gili, Holzhauer, Susanne, Alhenc Gelas, Martine, Finckh, Ulrich, Junker, Ralf, Heller, Christine, Zieger, Barbara, Kurnik, Karin, Knöfler, Ralf, Mesters, Rolf, Halimeh, Susan, Nowak‐Göttl, Ulrike
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.11.2014
• Subjects: Adolescent; Age of Onset; Biological and medical sciences; Child; Child, Preschool; children; Cohort Studies; Female; genetics; Genotype; Germany - epidemiology; Hematologic and hematopoietic diseases; Humans; Infant; Infant, Newborn; Israel - epidemiology; Male; Medical sciences; Mutation, Missense; Platelet diseases and coagulopathies; Prevalence; Protein C - genetics; protein C deficiency; Protein C Deficiency - blood; Protein C Deficiency - complications; Protein C Deficiency - diagnosis; Protein C Deficiency - epidemiology; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; purpura fulminans; Purpura Fulminans - epidemiology; Purpura Fulminans - etiology; Risk Factors; Stroke - epidemiology; Stroke - etiology; Thrombophilia - blood; Thrombophilia - diagnosis; Thrombophilia - epidemiology; Thrombophilia - genetics; Thrombophlebitis - epidemiology; Thrombophlebitis - etiology; Tumors; Venous Thrombosis - blood; Venous Thrombosis - epidemiology; Venous Thrombosis - genetics; Young Adult; Europe; Germany; Israel; Human; Skin disease; Observational study; Hematology; Purpura fulminans; Deep vein thrombosis; Cardiovascular disease; Protein C; Hemopathy; Laboratory; Genetic disease; Venous disease; Vascular disease; Cancerology; Protein C deficiency; children; Cohort study; Genetics; Venous thrombosis; Thromboembolism; Child; Coagulopathy; protein C deficiency; genetics; purpura fulminans
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.13039

Summary Venous thromboembolism [TE] is a multifactorial disease and protein C deficiency [PCD] constitutes a major risk factor. In the present study the prevalence of PCD and the clinical presentation at TE onset, including neonatal purpura fulminans, in a cohort of children are reported. In 367 unselected children (0·1–19 years) recruited between July 1996 and December 2013, a comprehensive thrombophilia screening was performed along with recording of anamnestic data. Twenty‐five of 338 children (7·4%) had PCD. Mean age at first TE onset was 10 years (range 0·1–18). Leading thromboembolic manifestations were neonatal purpura fulminans (n = 5), TE of cerebral veins (n = 3), stroke (n = 2) deep veinthrombosis (DVT) of the leg (n = 10), DVT & pulmonary embolism (n = 2) and DVT & pelvic veins (n = 3). Concomitant risk factors for TE were identified in 12 patients, whereas 13 children spontaneously developed TE. A positive family history of DVT was found in 10 children. In this unselected cohort of paediatric patients with symptomatic TE the overall prevalence of PCD was 7·4%; 1·5% presented with neonatal purpura fulminans. Given its clinical implication for patients and family members, thrombophilia testing should be performed and the benefit of medical or educational interventions should be evaluated in this high‐risk population.