Adolescent male suffering from thrombosis is not uncommon

I. Wieland1, A. Biering2, K. W. Sykora1 (1Hannover, Germany, 2Wolfsburg, Germany)

Pediatric and neonatal thrombosis and hemostasis
Date: 17.02.2017,
Time: 17:15 - 18:15

Objective: Thromboses in childhood are rare with two peaks: in newborns and from beginning of puberty. Typically, thrombosis occurs in adolescent girls taking estrogen containing oral contraception. Here we report our adolescent patients with thrombosis from the past two years.

Methods: Altogether we treated 13 teenagers with thrombosis, 5 boys (38%) and 8 girls (62%) in our centre. The mean age of boys was 15.8 years (14-17) and of the girl 16.3 years (15-18).

Results: The localization of the thromboses was similar: 2 of the 8 girls (25%) had a cerebral sinus venous and 5 (63%) a lower extremity deep venous thrombosis. Two of these had pulmonary arterial embolism. Among the boys, one suffered from sinus vein thrombosis. The other four (80%) suffered from deep vein thrombosis, all with concomitant pulmonary arterial embolism. In both groups it lasted from the first symptoms to the diagnosis between 1 day and 2 weeks. All of the girls took estrogen containing oral contraception. All had additional hereditary or exogenous thrombophilic risk factors: a heterozygote Factor V Leiden mutation (3/6, 50%), one a Prothrombin-mutation (1/6, 17%), two an increased lipoprotein a (2/6, 33%). Two had no hereditary thrombophilic risk factors but one a 6 hour bus ride and one an immobilization with a plaster cast. In the group of the boys, two had a heterozygote Factor V Leiden mutation (2/5, 40%), two (2/5, 40%) an antiphospholipid syndrome (APS), one of them in the setting of lupus erythematodes. In one case we could not find a hereditary thrombophilic risk factor. Only one of these patients had with the obesity an additional exogenous thrombophilic risk factor. All the others were lean, athletic young men without surgery, long-lasting journey or flight, immobilization or doping.

Conclusion: Adolescent male suffering from thrombosis is not uncommon. Interestingly, APS was reported to concern primarily female patients. In our patient population only adolescent boys were affected. Therefore we recommend screening for APS also in all boys with thrombosis. Perhaps because thrombosis is rare in childhood, in many cases, it takes a long time from the first symptoms to the correct diagnosis.