Treatment of a child with submassive pulmonary embolism associated with hereditary spherocytosis using ultrasound-assisted catheter-directed thrombolysis

Marvin Kajy, Nimrod Blank, M. Chadi Alraies, Jyothsna Akam-Venkata, Sanjeev Aggarwal, Amir Kaki, Tamam Mohamad, Mahir Elder, Theodore Schreiber

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The clinical presentation of hereditary spherocytosis varies fromno symptoms to severe hemolytic anemia requiring splenectomy. Splenectomy imposes the risk of hypercoagulability and acute pulmonary embolism.Catheter-directed thrombolysis is an established treatment for submassive pulmonary embolism in adults. However, the literature regarding its use in children is limited. Case Report: We present the case of a 12-year-old male with hereditary spherocytosis who was diagnosed with pulmonary embolism and successfully treated with catheter-directed thrombolysis. The patient was initially treated with 10.5mg of recombinant tissue plasminogen activator (r-tPA) delivered over 8 hours. However, because ofminimal clinical and hemodynamic improvement, a second course of thrombolytic was administered for an additional 24 hours (25 mg of r-tPA), and the treatment resulted in marked clinical and hemodynamic improvement. Clot resolution was confirmed via angiography. The patient was discharged on enoxaparin and with regular follow-up. One year later, the patient was asymptomatic on enoxaparin. Conclusion: This case demonstrates that catheter-based treatment of submassive pulmonary embolism restores hemodynamic stability and thus is an alternative to surgery or systemic thrombolysis, even in the pediatric setting.While catheter-directed thrombolysis is a safe and effective alternative to systemic thrombolysis, further research is needed to establish appropriate dosing and indications in the adolescent population.

Original languageEnglish
Pages (from-to)264-270
Number of pages7
JournalOchsner Journal
Volume19
Issue number3
DOIs
StatePublished - Sep 2019

Keywords

  • Endovascular procedures
  • Mechanical thrombolysis
  • Pulmonary embolism
  • Spherocytosis-hereditary
  • Thrombolytic therapy
  • Tissue plasminogen activator
  • Vascular access devices

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