Coagulation Abnormalities and Clinical Complications in Children With SARS-CoV-2: A Systematic Review of 48,322 Patients

Abstract

Given the limited information on the coagulation abnormalities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric patients, we designed a systematic review to evaluate this topic. A comprehensive literature search was conducted for “SARS-CoV-2,” “coagulopathy,” and “pediatrics.” Two authors independently screened the articles that the search returned for bleeding, thrombosis, anticoagulant and/or antiplatelet usage, and abnormal laboratory markers in pediatric patients with SARS-CoV-2, and the authors then extracted the relevant data. One hundred twenty-six publications were included. Thirty-four (27%) studies reported thrombotic complications in 504 patients. Thirty-one (25%) studies reported bleeding complications in 410 patients. Ninety-eight (78%) studies reported abnormal laboratory values in 6580 patients. Finally, 56 (44%) studies reported anticoagulant and/or antiplatelet usage in 3124 patients. The variety of laboratory abnormalities and coagulation complications associated with SARS-CoV-2 presented in this review highlights the complexity and variability of the disease presentation in infants and children.

Thromboembolic complications in children with COVID-19 and MIS-C: A narrative review

“…In adults with COVID-19, D-dimer levels are associated with thrombosis and poor outcome ( 78 ), while in children their predictive role is quite more controversial. High D-dimers are described in around 20% of children with SARS-CoV-2 infection ( 79 ), but their association with thrombosis was found only in children with MIS-C ( 5 ). In the present review, most patients with a thrombotic complication had elevated D-dimers, in many cases exceeding the ULN of more than five times.…”

COVID‐19‐associated coagulopathy in children: A multicenter observational cohort study

“…These observed coagulopathy parameters are consistent with other studies. Several adult and pediatric studies have documented D-dimer [9][10][11][12][13][14][15] and fibrinogen 9,11,12,15 elevation. In this study, 52% patients had PT prolongation.…”

Hematologic manifestations of coronavirus disease 2019 in children: Case-series report and a review

“…According to Per Cui et al, the reduction of lymphocytes in children was only 16%, but in adults, it was up to 43.1, 57.4, and 56%, respectively, reported by a previous meta-analysis; the reason for these differences may be related to the immune response of different organisms to novel coronavirus ( 17 ). Other abnormal lab parameters reported have included coagulation profile abnormalities ( 18 ).…”

“…Bleeding events occur less frequently than thrombotic events and are incompletely understood ( 18 ). Microvascular thrombosis and thrombocytopenia are reported to contribute to bleeding events in pediatric patients; cutaneous bleeding, presenting as petechiae, microhemorrhages in the extremities, erythema, macular eruptions, and purpura, often labeled as chilblains was the most common bleeding event reported ( 18 ).…”