How can blood clots affect your child in the future?

Definitions:

• Chronic venous insufficiency: A condition where veins no longer work well to bring blood back toward the heart.
• Post thrombotic syndrome or PTS: When chronic venous insufficiency occurs after a DVT in the arm or leg or in the veins that return blood from the arm/leg to the heart, we call that post-thrombotic syndrome (PTS).
• Symptoms may include swelling of an arm or leg where a DVT has occurred, color changes, a rash, or sores on the skin, and pain or tingling
• Esophagus: The part of your digestive system that carries food and liquid from your mouth to your stomach.
• Graduated compression stockings: Custom-fit stockings that can provide some relief from the symptoms of post-thrombotic syndrome or PTS.
• Hepatic: Refers to the liver.
• Portal vein: The main vein that brings blood from the liver to the intestine.
• Hepatic and portal vein blood clots: Blood clots in veins that return blood back to the heart from the liver and digestive system.
• Low blood cell counts: a decrease in white blood cells, red blood cells, and/or platelets that indicates a problem with your health.
• Pulmonary artery: The large artery that brings blood from the heart to the lungs.
• Pulmonary hypertension: Increased pressure in the pulmonary artery that can cause long-term breathing problems.
• Renal: Refers to the kidneys.
• Renal vein blood clots: Blood clots in the vein that returns blood from the kidney back toward the heart.

Potential long-term effects of blood clots depend on the parts or of the body or organs involved. For example:

• Children with renal (kidney) vein blood clots can develop high blood pressure.

• Blood clots in the hepatic (liver) vein or portal vein can enlarge your child’s spleen.

  • These blood clots also can cause bleeding problems in the stomach and esophagus from increased pressure in the veins that return blood to the heart from these areas.

  • The enlarged spleen can cause your child to have low blood cell counts.

• Following a PE, children can sometimes develop long-term breathing problems from “pulmonary hypertension” This not common in children. When it happens, pressure increases in the pulmonary artery that brings blood from the heart to the lungs.

• After your child experiences a DVT, the vein with the DVT and veins that drain into it may no longer work as well.

  • Your child’s veins may not bring blood back toward the heart as well as they did before the DVT.

  • We call this condition “chronic venous insufficiency.”

• If your child’s had an arm or leg DVT, this can cause long-term changes in your child’s arm or leg.

  • These changes can include swelling, color changes, a rash or sores on the skin, and pain, aching or tingling.

  • We call this type of chronic venous insufficiency “post-thrombotic syndrome,” or “PTS”.

• In mild cases of PTS, the symptoms come and go. In more severe cases, symptoms do not go away.

• About 25% of children and adults will develop PTS after an arm or leg DVT.

• The risk appears much higher in children who develop a second DVT in the same leg or arm.

• The use of custom-fit elastic stockings called “graduated compression stockings” can provide some relief from the symptoms of PTS.

  • Some preliminary research suggests a specific exercise regimen can improve PTS symptoms in adults who had leg DVTs.

  • The exercise program includes calf strengthening and stretching, and regular use of a treadmill.

• The best way to prevent PTS is to prevent DVT.

Neil A. Goldenberg, MD, PhD

Associate Professor of Pediatrics and Medicine, Johns Hopkins University School of Medicine,
Baltimore, MD, USA

Chief Research Officer and Director, Thrombosis Program,
All Children’s Hospital Johns Hopkins Medicine and All Children’s Research Institute,
St. Petersburg, FL, USA    March 2014

Download: Blood Clots and Children Resource PDF