Background: There is a paucity of information regarding community acquired pulmonary embolism in children, and only one study directly compared community to hospital acquired pulmonary embolism in children. This study gathered data on children with community versus hospital acquired pulmonary embolism at a single institution over a 13-year period. Procedures: Children with pulmonary embolism were identified by a query of the hospital’s information system using diagnostic codes. Gathered data included demographics, presenting signs and symptoms, origin of the event, risk factors, treatment received, and outcomes. Results: Sixty-five children were identified as having a pulmonary embolism. Of these, 53 were community acquired. Female sex, adolescents, contraceptive use, and an elevated body mass index were identified as potential risk factors for community acquired pulmonary embolism. A deep vein thrombosis was found in a minority (30%) of patients who were imaged. Conclusions: As with other studies, the majority of children with pulmonary embolism at our institution were community acquired. Risk factors for venous thromboembolism in children are often derived by comparing children admitted with venous thromboembolism to other inpatients. Since community acquired pulmonary embolism seems to be more prevalent, comparisons to inpatients without a pulmonary embolism may not be valid. The combination of female sex, adolescents, elevated body mass index, community acquired pulmonary embolism in the absence of a deep vein thrombosis was present in 23% of our patients. This combination serves as potential risk factors for future investigations.

Background: Multiple studies have now shown that a significant proportion of hemophilia carriers meet criteria for having hemophilia and/or report abnormal bleeding. However, to date, investigations of hemophilia carriers have almost exclusively involved women over 18 years of age. Little is known about factor activity levels and bleeding scores in carriers during childhood. We queried a large deidentified database of subjects with bleeding disorders residing in the United States to determine factor activity levels and bleeding scores. Procedures: The ATHNdataset was queried for hemophilia carriers under 18 years of age. Collected information included demographics, factor activity levels, bleeding scores. Results: Over 700 carriers in the pediatric age group were identified of which 626 submitted factor activity levels. Nearly half had factor activity levels less than 40 IU/dL, thereby meeting criteria for having hemophilia. Of those reporting bleeding scores, only 13.5% reported an abnormal bleeding score for age. The proportion reporting abnormal bleeding scores was higher in those with factor levels less than 40 IU/dL (23%) than those greater than 40 IU/dL (9.7%). Conclusions: The proportion of pediatric carriers with hemophilia was double of that previously reported for adults. Of those with hemophilia reporting a bleeding score, the majority (77%) did not report an abnormal bleeding score for age. However, nearly 10% of pediatric carriers not meeting criteria for having hemophilia reported abnormal bleeding scores for age. Similar results are reported in adults suggesting that factor activity levels may not be predictive of bleeding symptoms in carriers.

John Puetz MDSaint Louis University School of MedicineDepartment of PediatricsDivision of Pediatric Hematology/OncologySSM Health Cardinal Glennon Children’s Hospital1465 S. GrandSt. Louis MO 63104 USAPhone +1 314 577-5638Fax +1 314 577-5309Email: john.puetz@health.slu.edu