Hemostasis in children with COVID-19-RELATED illness

BACKGROUND: During the COVID-19 pandemic, the problem of coronavirus-associated coagulopathy was one of the most difficult and poorly studied. The detected hemostasis disorders in adults are extrapolated to children and adolescents without sufficient representation in the literature. Because of COVID-19 is generally told as a mild disease in children a detailed laboratory examination not required. As a result, thrombotic and hemorrhagic complications, as well as the children’s multisystem inflammatory syndrome (MIS-C) are unexpected. At the same time, the hemostasis assessment in children with COVID-19 is necessary for the coronavirus-associated coagulopathy timely diagnosis, adequate anticoagulant therapy prescribing, various convalescence thrombotic complications prevention, as well as determining the necessary period of dynamic monitoring of patients.

AIM: To assess the hemostasis in children with COVID-19-related illness in the acute disease period and convalescence.

MATERIALS AND METHODS: The results of the examination of 460 patients from 2 days to 18 years old hospitalized with confirmed SARS-CoV-2 infection and 110 outpatient children from 3 months to 17 years old at different periods of COVID-19 convalescence are presented. The study included platelet count measured using automated hematocytometers, the main coagulation laboratory parameters and D-dimer level.

RESULTS: The observational study indicate that children hospitalized with acute COVID-19-related illness have adult like coagulation changes, which significantly depend on the disease severity, presents of pneumonia and in the intensive care need cases, and the most sensitive indicator was the D-dimer level. However, there were opposite changes: both hyper- and hypocoagulation, a high frequency of normal or elevated platelet counts, as well as the presence of coagulopathy in 1/5 of cases even with a mild COVID-19 and the absence in 1/4 of severe cases. During the convalescence, coagulation laboratory parameters were normal, with the exception of an increased D-dimer level in every sixth patient within 1 month after recovery.

CONCLUSIONS: Hemostasis changes in children with COVID-19-related illness differ from the adults by opposite, duration and risk factors. The anticoagulant therapy selection and duration requires an individual approach with the hematologist assistance. Further studies are needed to clarify the causes and consequences of hemostasis changes in children with mild forms of novel coronavirus SARS-CoV-2 infection, to establish additional coronavirus-associated coagulopathy factors in children with moderate and severe COVID-19, to develop recommendations for anticoagulant therapy in childhood.