Paediatric thrombo-embolism: the influence of non-genetic factors and the role of activated protein C resistance and protein C deficiency.
In many children, the pathogenesis of thrombo-embolism remains unexplained. This study examines the role of non-genetic risk factors in 37 children with venous or arterial thrombosis. Included were 17 patients with portal vein thrombosis following umbilical vein catheterisation, 6 with portal vein thrombosis and an uneventful neonatal period, 4 with deep vein thrombosis, 4 with renal vein thrombosis after kidney transplantation, 1 haemodialysis patient with thromboses of arteriovenous shunts, and 5 with arterial thromboses at various sites. In 25 of these 37 patients (68%) exogenic risk factors and particularly vascular manipulations (24/37) were related to the thrombotic event. Resistance to activated protein C was identified in 5 patients and protein C deficiency in 2 (7/37; 19%). This prevalence was significantly higher than that of the control group (14/243; 5.8%; chi 2, P < 0.008).


CONCLUSIONS
Our data show that non-genetic and particular iatrogenic risk factors can often be identified in children with thrombosis, but activated protein C resistance and protein C deficiency are significant genetic risk factors in this age group.
Uttenreuther-Fischer
M M
MM
Charité-Virchow Medical center, Department of General Paediatrics, Berlin, Germany.
Vetter
B
B
Hellmann
C
C
Otting
U
U
Ziemer
S
S
Hausdorf
G
G
Gaedicke
G
G
Kulozik
A E
AE
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005165:Factor V / Q000235:genetics; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D011486:Protein C / Q000235:genetics / Q000378:metabolism*; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000235:genetics; D013924:Thrombophlebitis / Q000453:epidemiology* / Q000235:genetics
D011486:Protein C; D005165:Factor V