Hematologic manifestations of SARS-CoV-2 infection and MIS-C in
hospitalized children. Results of the PICNIC registry.
Abstract
Introduction: Hematologic complications of SARS-CoV-2 infection are well
described in hospitalized adults with correlation to adverse outcomes.
Information published in children has been limited. Methods: An
international multi-centered retrospective registry was established to
collect data on the clinical manifestations of SARS-CoV-2 or multisystem
inflammatory syndrome (MIS-C) in hospitalized children between February
1, 2020 – May 31, 2021. This sub-study focused on hematologic
manifestations. Study variables included patient demographics,
comorbidities, clinical presentation, course, laboratory parameters,
management, and outcomes. Results: Nine hundred and eighty-five children
were enrolled and 915 (93%) had clinical information available; 385
(42%) had symptomatic SARS-CoV-2 infection upon admission, 288 had
MIS-C (31.4%) and 242 (26.4%) had alternate diagnosis with SARS-CoV-2
identified incidentally. During hospitalization, 10 children (1%)
experienced a thrombotic event, 16 (1.7%) had hemorrhage and 2 (0.2%)
had both thrombotic and hemorrhagic episodes. Significant prothrombotic
comorbidities included congenital heart disease (p-value = 0.007),
central venous catheter (p = 0.04) in children with primary SARS-CoV-2
infection; and obesity (p-value= 0.002), cytokine storm (p= 0.012) in
those with MIS-C. Significant pro- hemorrhagic conditions included age
> 10 years (p = 0.04), CVC (p= 0.03) in children with
primary SARS-CoV-2infection; and thrombocytopenia (0.001), cytokine
storm (0.02) in those with MIS-C. Eleven patients died (1.2 %) with no
deaths attributed to thrombosis or hemorrhage Conclusion: Thrombotic and
hemorrhagic complications are uncommon in children with SARS-CoV-2
infection and observed with underlying co-morbid conditions.
Understanding the complete spectrum of hematologic complications in
children with SARS-CoV-2 infection or MIS-C requires ongoing
multi-center studies.