Problemi speciali
La trombosi venosa nel bambino
Venous thrombosis in children: diagnosis and treatment
Emilia Parodi1, Giovanni Del Borrello2, Chiara Portulano2, Lorenzo Riboldi2, Paola Saracco1, Ugo Ramenghi1,3
1Ematologia Pediatrica, Ospedale Infantile “Regina Margherita”, Torino
2Scuola di Specializzazione in Pediatria, 3Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino
Febbraio 2021 - pagg. 103 -108 | DOI: 10.53126/MEB40103
Abstract
Venous thrombosis is a complication that mostly occurs in the paediatric patient with multiple comorbidities. In these cases, it is relatively simple for the paediatrician to suspect the presence of a thrombosis. On the contrary, due to the rarity of the pathology and the clinical presentation that can mimic other conditions, it could be difficult to recognize a thrombotic event in an extra-hospital context and in an "otherwise healthy" child. This article aims to examine how to diagnose and treat this rare paediatric condition promptly
Riassunto
Nella maggioranza dei casi, la trombosi venosa è una complicanza che insorge nel paziente pediatrico con multiple comorbidità. In questi casi è relativamente facile per il pediatra sospettare la presenza di una trombosi. Al contrario, complici la rarità della patologia e la presentazione clinica che può mimare altre condizioni, può essere difficile riconoscere un evento trombotico in un contesto extra-ospedaliero e in un bambino “altrimenti sano”.
Questo articolo si propone di esaminare rapidamente i principi di diagnosi e terapia di questa rara condizione pediatrica.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Andrew M, David M, Adams M, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994;83(5):1251-7.
2. Stein PD, Kayali F, Olson RE. Incidence of venous thromboembolism in infants and children: Data from the National Hospital Discharge Survey. J Pediatr 2004;145(4):563-5. DOI: 10.1016/j.jpeds.2004.06.021.
3. Mahajerin A, Betensky M, Goldenberg NA. Thrombosis in children: approach to anatomic risks, thrombophilia, prevention, and treatment. Hematol Oncol Clin North Am 2019;33(3):439-3. DOI: 10.1016/j.hoc. 2019.01.009.
4. Raffini L, Huang Y-S, Witmer C, et al. Dramatic Increase in Venous Thromboembolism in Children’s Hospitals in the United States From 2001 to 2007. Pediatrics 2009;124(4): 1001-8. DOI: 10.1542/peds.2009-0768.
5. Setty BA, O’Brien SH, Kerlin BA. Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer 2012;59(2):258-64. DOI: 10.1002/pbc.23388.
6. Lolli V, Molinari F, Pruvo JP, Soto Ares G. Radiological and clinical features of cerebral sinovenous thrombosis in newborns and older children. J Neuroradiol 2016;43(4):280-9. DOI: 10.1016/j.neurad.2015.12.001.
7. Cox M, Epelman M, Chandra T, et al. Non-catheter-related venous thromboembolism in children: imaging review from head to toe. RadioGraphics 2017;37(6):1753-74. DOI: 10.1148/rg.2017170036.
8. Biss TT, Brandão LR, Kahr WH, Chan AK, Williams S. Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism. J Thromb Haemost 2009;7(10):1633-8. DOI: 10.1111/ j.1538-7836.2009.03572.x.
9. Moran J, Bauer KA. Managing thromboembolic risk in patients with hereditary and acquired thrombophilias. Blood 2020;135 (5):344-50. DOI: 10.1182/blood.2019000917.
10. Nowak-Göttl U, van Ommen H, Kenet G. Thrombophilia testing in children: What and when should be tested? Thromb Res 2018; 164:75-8. DOI: 10.1016/j.thromres.2018.02. 136.
11. Witmer C, Raffini L. Treatment of venous thromboembolism in pediatric patients. Blood 2020;135(5):335-43. DOI: 10.1182/ blood.2019001847.
12. Monagle P, Cuello CA, Augustine C, et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv 2018;2(22):3292-316. DOI: 10.1182/bloodadvances.2018024786.
13. Jaffray J, Goldenberg N. Current approaches in the treatment of catheter-related deep venous thrombosis in children. Expert Rev Hematol 2020;13(6):607-17. DOI: 10. 1080/17474086.2020.1756260.
14. Ferro JM, Bousser M-G, Canhão P, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24(10):1203-13. DOI: 10.1111/ene.13381.
15. Betensky M, Goldenberg NA. Post-thrombotic syndrome in children. Thromb Res 2018;164:129-35. DOI: 10.1016/j.thromres.2017.07.024.
16. Newall F, Branchford B, Male C. Anticoagulant prophylaxis and therapy in children: current challenges and emerging issues. J Thromb Haemost 2018;16(2):196-208. DOI: 10.1111/jth.13913.
17. Avila ML, Amiri N, Stanojevic S, et al. Can thrombophilia predict recurrent catheter-related deep vein thrombosis in children?. Blood 2018;131(24):2712-9. DOI: 10.1182/ blood-2017-10-811216.
18. Giglia TM, Massicotte MP, Tweddell JS, et al. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease. Circulation 2013;128(24):2622-703. DOI: 10.1161/01.cir.0000436140.77832.7a.
Corrispondenza: ugo.ramenghi@unito.it