Results
The demographics and laboratory values of eight hospitalized children
diagnosed with SARS-CoV-2 infection are shown in Table 1. Average age
was 12.9 years, with equal gender distribution and 38% were overweight
or obese (BMI >25 kg/m2 or
>30 kg/m2 respectively). Seventy-five
percent required oxygen supplementation and 63% required ICU admission.
Central lines in 25% remained in place for an average of 6 days; half
of the patients were treated with hydroxychloroquine and 25% received
Remdesivir (compassionate use, Gilead Sciences). Prophylactic enoxaparin
(0.5 mg/kg/dose subcutaneously every 12 hours) was initiated in patients
based on institutional adult guidelines of oxygen requirement, and
elevated D-dimer levels. It was escalated to therapeutic enoxaparin (1
mg/kg/dose subcutaneously every 12 hours) in 63 % of patients for
clinical deterioration with increasing hypoxia requiring admission to
intensive care and/ or ventilator support. Anti-Xa levels were monitored
only in the presence of deteriorating renal function or thrombocytopenia
to reduce clinical staff exposure. There were no observed bleeding
complications, thromboembolic complications or deaths.
Abnormal laboratory data expressed as means included lymphopenia
(37.5%), mild thrombocytopenia (13 %), prolonged PT (50 %), elevated
ferritin (37%) and C-reactive protein (88%). Elevations in D-dimer
levels (75%), and fibrinogen (88 %) were observed on the day ROTEM was
drawn for analyses.
ROTEM analysis (Table 2) showed a predominance of hypercoagulable
profiles with elevated EXTEM MCF (50%), elevated INTEM MCF (38%), and
both elevated FIBTEM A10/20 and elevated FIBTEM MCF (in 75% of
patients), which is comparable to that seen in adults. Averages and
ranges cannot be reported due to variability of age-based reference
ranges in pediatrics10. There was no statistically
significant correlation between fibrinogen and EXTEM MCF (p=0.116),
INTEM MCF (p=0.232) or FIBTEM MCF (p=0.130) on the day ROTEM was
obtained, nor was there correlation of d-dimer levels with these
parameters [d-dimer and EXTEM MCF (p=0.949), INTEM MCF (p=0.731) or
FIBTEM MCF (p=0.748)]. However, we observed that all patients admitted
to the ICU had a 3 to 10-fold elevation in D-dimer levels, and a 2- fold
elevation in fibrinogen levels and 80 % of the patients had elevated
FIBTEM parameters.