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Hematologic manifestations of SARS-CoV-2 infection and MIS-C in hospitalized children. Results of the PICNIC registry.
  • +38
  • Sarah Tehseen,
  • Suzan Williams,
  • Joan Robinson,
  • Shaun Morris,
  • Tala Tal,
  • Ari Bitnun,
  • Peter Gill,
  • Ann Yeh,
  • Carmen Yea,
  • Helena Brenes-Chacon,
  • Adriana Yock-Corrales,
  • Rolando Ulloa-Gutierrez,
  • Gabriela Ivankovich-Escoto,
  • Alejandra Soriano-Fallas,
  • Jesse Papenburg,
  • Marie-Astrid Lefebvre,
  • Rosie Scuccimarri,
  • Alireza Nateghian,
  • Behzad Aski,
  • Rachel Dwilow,
  • Jared Bullard,
  • Leo Restivo,
  • Suzette Cooke,
  • Alison Lopez,
  • Ashley Roberts,
  • Manish Sadarangani,
  • Michelle Barton Forbes,
  • Nicole Saux,
  • Jennifer Bowes,
  • Rupeena Purewal,
  • Janell Lautermilch,
  • Ann Bayliss,
  • Jacqueline Wong,
  • Kirk Leifso,
  • Cheryl Foo,
  • Luc Panetta,
  • Fatima Kakkar,
  • Dominique Piche,
  • Isabelle Viel-Theriault,
  • Joanna Merckx,
  • Lani Lieberman
Sarah Tehseen
University of Saskatchewan

Corresponding Author:sarah.tehseen@saskhealthauthority.ca

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Suzan Williams
The Hospital for Sick Children
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Joan Robinson
University of Alberta
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Shaun Morris
The Hospital for Sick Children
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Tala Tal
The Hospital for Sick Children
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Ari Bitnun
The Hospital for Sick Children
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Peter Gill
The Hospital for Sick Children
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Ann Yeh
The Hospital for Sick Children
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Carmen Yea
SickKids Research Institute
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Helena Brenes-Chacon
Hospital Nacional de Ninos Dr Carlos Saenz Herrera
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Adriana Yock-Corrales
Hospital Nacional de Ninos Dr Carlos Saenz Herrera
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Rolando Ulloa-Gutierrez
Hospital Nacional de Ninos Dr Carlos Saenz Herrera
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Gabriela Ivankovich-Escoto
Hospital Nacional de Ninos Dr Carlos Saenz Herrera
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Alejandra Soriano-Fallas
Hospital Nacional de Ninos Dr Carlos Saenz Herrera
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Jesse Papenburg
McGill University Faculty of Medicine
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Marie-Astrid Lefebvre
McGill University Faculty of Medicine
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Rosie Scuccimarri
McGill University Faculty of Medicine
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Alireza Nateghian
Iran University of Medical Sciences
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Behzad Aski
Iran University of Medical Sciences
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Rachel Dwilow
University of Manitoba Faculty of Health Sciences
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Jared Bullard
University of Manitoba Faculty of Health Sciences
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Leo Restivo
University of Calgary Faculty of Medicine
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Suzette Cooke
University of Calgary Faculty of Medicine
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Alison Lopez
The University of British Columbia Faculty of Medicine
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Ashley Roberts
The University of British Columbia Faculty of Medicine
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Manish Sadarangani
BC Children's Hospital Research Institute
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Michelle Barton Forbes
London Health Sciences Centre Children's Hospital
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Nicole Saux
University of Ottawa Faculty of Medicine
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Jennifer Bowes
University of Ottawa Faculty of Medicine
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Rupeena Purewal
University of Saskatchewan
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Janell Lautermilch
University of Saskatchewan College of Medicine
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Ann Bayliss
Trillium Health Partners
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Jacqueline Wong
McMaster University Faculty of Health Sciences
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Kirk Leifso
Queen's University
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Cheryl Foo
Memorial University of Newfoundland
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Luc Panetta
University of Montreal Faculty of Medicine
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Fatima Kakkar
University of Montreal Faculty of Medicine
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Dominique Piche
Dalhousie University Faculty of Medicine
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Isabelle Viel-Theriault
Laval University Faculty of Medicine
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Joanna Merckx
McGill University Faculty of Medicine and Health Sciences
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Lani Lieberman
University Health Network
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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.
31 Dec 2021Submission Checks Completed
31 Dec 2021Assigned to Editor
31 Dec 2021Submitted to Pediatric Blood & Cancer
12 Jan 2022Reviewer(s) Assigned
28 Jan 2022Review(s) Completed, Editorial Evaluation Pending
01 Feb 2022Editorial Decision: Revise Major
06 Apr 20221st Revision Received
06 Apr 2022Submission Checks Completed
06 Apr 2022Assigned to Editor
10 Apr 2022Reviewer(s) Assigned
25 Apr 2022Review(s) Completed, Editorial Evaluation Pending
27 Apr 2022Editorial Decision: Accept