Low hemoglobin as a biomarker for paediatric sinus thrombosis

ABSTRACT

Background: Cerebral venous sinus thrombosis (CVST) is rare in children. Its risk factors and outcome are largely unknown in low-middle income countries. Some case reports have shown presence of anemia in pediatric CVST as a probable risk factor. Aims: This study was done to determine the frequency of anemia in patients having pediatric CVST and to observe its association with the severity of disease. Methods: Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were identified through international classification of diseases (ICD 9). Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Results: Of 143492 patients who were admitted, 32 (21 males and 11 females) with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 2.2 CVST events /10,000 pediatric admissions. Overall mortality was 3.4%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Significant laboratory findings were anemia (65%), low protein S (19%), low protein C (19%), low antithrombin III (6%) and activated protein C resistance (25%). Mean(±SD) hemoglobin in anemic patients was 9.0 g/dL (±2.3). SARS-COV2 was negative in patients tested in 2020. Regression analysis showed a positive association of anemia with multiple sinus involvement ( P 0.009) but anemia had no association with the duration of symptoms ( P 0.344), hospital stay ( P 0.466), age ( P 0.863) or gender ( P 0.542) of the patients. Conclusions: Low hemoglobin was observed in a significant proportion of patients with pediatric CVST. Anemia may be an important biomarker along with other clinical variables in the risk assessment of sinus thrombosis in children. Future studies may unveil the role of anemia in coagulopathy and more specifically in pediatric CVST.