Prevalence of thrombophilia and central venous catheter-associated neck vein thrombosis in 41 children with cancer--a prospective study.
BACKGROUND
This study was designed to prospectively evaluate the prevalence of thrombophilia and central venous catheter-associated neck vein thrombosis in children with cancer.


METHODS
Children with cancer and central lines, treated at the National Hospital in Norway, were consecutively enrolled in the study. Biochemical analysis of thrombophilia and Doppler ultrasonography of neck veins were performed at inclusion, and ultrasonography was repeated 3-5 months later. We recorded systematically positive blood-cultures and days with intravenous antibiotics. In a subgroup of 13 patients with acute lymphoblastic leukaemia, the thrombophilia parameters were re-evaluated during asparaginase therapy.


RESULTS
Forty-one children were included in the study and observed for a mean of 266 days (range 95-569 days). Eighteen patients (44%) developed venous thrombosis (VT), visualized by Doppler ultrasonography of the catheterized vein. Some clots were transient, but blood clots with diameters > 0.5 cm (n = 11) had a tendency to remain (P = 0.14). Twelve children (29%) were classified as thrombophilic at inclusion, with elevated serum levels of homocysteine and lipoprotein (a) as the most frequent alterations. Transient thrombophilia developed in all patients during asparaginase-therapy. Within the limitations of our study, we did not find any significant correlation between thrombophilia and development of VT, nor thrombosis and infectious disease.


CONCLUSIONS
VT develops frequently in paediatric cancer patients with central lines, but the clinical implication of this observation remains to be clarified.
Ruud
Ellen
E
Department of Pediatrics, The National Hospital, Norway. ellen.ruud@rikshospitalet.no
Holmstrøm
Henrik
H
Natvig
Solveig
S
Wesenberg
Finn
F
D000293:Adolescent; D001932:Brain Neoplasms / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000628:therapy*; D008223:Lymphoma / Q000628:therapy; D008297:Male; D009333:Neck / Q000098:blood supply*; D011446:Prospective Studies; D019851:Thrombophilia / Q000209:etiology*; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*