🩸 Chapter 528 · Thrombotic Disorders in Children

Nelson Textbook of Pediatrics 22nd Edition | Pediatric thrombosis: venous thromboembolism (VTE), central venous catheter (CVC)-related thrombosis (most common), cerebral sinovenous thrombosis (CSVT), pulmonary embolism (PE), arterial thrombosis, renal vein thrombosis (neonates), portal vein thrombosis. Risk factors: CVC, cancer, surgery, trauma, infection, inherited thrombophilia. Treatment: anticoagulation (LMWH, warfarin, DOACs), thrombolysis (tPA) for life/limb-threatening thrombosis. Complications: post-thrombotic syndrome (PTS).

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📋 30 Clinical Scenarios — Pediatric Thrombotic Disorders

📇 High‑Yield Review Cards (Pediatric Thrombosis)

🩺 Clinical Recognition: Pediatric Thrombosis

Select a presentation for diagnostic clues and management.

📋 Stepwise Management of Pediatric Thrombosis

🔑 Key Principles — Nelson Chapter 528
• Most common risk factor: central venous catheter (CVC) — associated with ~60% of pediatric VTE.
• Diagnosis: Ultrasound (extremity DVT), CT angiography (PE), MRI/MRV (CSVT, portal vein).
• Anticoagulation: LMWH (enoxaparin) first-line. Transition to warfarin (INR 2-3) or DOAC (rivaroxaban, dabigatran) for outpatient management.
• Duration: Provoked VTE (CVC, surgery) → 3 months. Unprovoked VTE → 6-12 months. Strong thrombophilia or recurrent VTE → indefinite.
• Thrombolysis (tPA): Reserved for life- or limb-threatening thrombosis (massive PE, phlegmasia cerulea dolens, acute limb ischemia).
• Post-thrombotic syndrome (PTS): Chronic pain, swelling, discoloration; occurs in 20-50% of pediatric DVT.

    ⚡ Reflex Prompts — Clinical Decisions in Pediatric Thrombosis

    📖 Summary: Thrombotic Disorders in Children — Nelson Ch 528