PB0077 - Hematologic Findings and Complications of SARS-COV-2 in Children and Young Adults

Background: Thrombotic coagulopathy is a predictor of SARS-CoV-2 infection related mortality in adults (1-4). Incidence of venous thromboembolic events (VTE) in children seems to be lower (5), but there remains paucity of data on this in children. The current study describes the coagulation and inflammatory disturbances occurring in children < 21 years with SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C) and evaluates risk factors for hematologic complications.

Aims: 1. Report hematological and inflammatory abnormalities and hemorrhagic/thrombotic outcomes, in pediatric patients with SARS-CoV-2 or MIS-C.
2. Identify risk factors for hematologic adverse outcomes with SARS-CoV-2 or MIS-C.

Methods: Single-institution, retrospective study of in children < 21 years with SARS-CoV2 acute infection or MIS-C between March 1, 2020, and February 28, 2021. Laboratory parameters were collected at presentation, and during hospitalization. Bleeding was graded using the modified World Health Organizations (WHO) grading system. VTEs were diagnosed radiographically, or by strong clinical suspicion. Correlation studies were done to assess hematologic and inflammatory laboratory markers.

Results: In pediatric patients with SARS-COV-2 infection and MIS-C (n=127), we identified thrombotic and bleeding complications incidences at 6.3% and 6.3%, respectively. VTEs and bleeding events occurred mainly in females. All thrombotic events occurred in patients not previously on anticoagulation. No patients in our study received post-discharge thromboprophylaxis; one VTE occurred three days after discharge for COVID-19 pneumonia. Adolescent age (>13 y) and indwelling central venous-access device (CVAD) increased thrombotic risk, while MIS-C diagnosis did not. Obesity was not a risk factor for VTE but was associated with increased bleeding risk. Seven of eight bleeding events (5.5%) were WHO grade 3.

Conclusion(s): SARS-CoV-2 thrombotic complications in children are occur at lower rates than in adults. Older age, female sex, and CVADs increase thrombotic risk. With higher rates of bleeding events our study, daily risk-assessment of the need for continued thromboprophylaxis is recommended.