Illustration of a blood clot (Stock image)
With increased rates of blood clots in children—especially those who are hospitalized—the need for a dedicated pediatric thrombosis program at Children’s of Alabama came to fruition five years ago. Since then, the program has made its mark by creating institutional guidelines for venous thromboembolism (VTE) management, developing educational materials for patients and families, and participating in prestigious clinical trials.
“We’ve grown tremendously—it didn’t take long to get the word out,” said Children’s pediatric hematologist Hope Pritchett Wilson, M.D., who is also an assistant professor in the Division of Hematology & Oncology at the University of Alabama at Birmingham (UAB). “Most of it is through word of mouth alone.”
This past year proved record-breaking for the program, exceeding the yearly average of 50 to 60 new thrombosis diagnoses in young patients. What accounts for its growth? Wilson explained that advances in critical care for the sickest children, which often involves placing a central venous catheter, makes clotting more likely. VTE awareness has also grown, enabling clinicians here and elsewhere to better pinpoint affected children.
But managing these children’s care is often a long-term prospect. Girls, for example, may be unable to use estrogen-based medications for menstrual problems or birth control, while student-athletes on blood thinners may need to refrain from contact sports due to an increased bleeding risk. A small subset of young patients will need lifelong anticoagulation therapies.
At Children’s dedicated thrombosis clinic, held every Thursday, clinicians are now receiving referrals from all across the city and state. A multidisciplinary staff that includes specialists in hematology and pharmacy as well as a nurse practitioner, nurse coordinator and research nurse means the team can “all bring different expertise and lived experiences to think of a child holistically,” Wilson said. “One of the more recent collaborations we’ve established, with interventional radiologists, offers a direct path to patients who may need further intervention and may benefit from various procedures.”
The team’s mounting expertise has empowered them to develop institutional guidelines for VTE management tailored to patients here and create more effective educational materials for patients and families. The clinic has also participated in prestigious clinical trials—including a pivotal international multi-center study comparing outcomes with six weeks versus three months of VTE treatment in children—that have proven practice-changing.
“As we see results, we can implement them directly,” Wilson said. “Our names are in the conversation now regarding different trials because we provide quality care, have high patient volume and successfully enroll children into clinical trials.”
Moving forward, Wilson said the program may begin other forms of outreach in an attempt to pinpoint all children who might benefit from its expertise and efforts. Staff members are planning to survey families whose children are seen in the clinic about gaps or barriers to ensure more equitable care.
“Now that we’ve established ourselves, let’s go back and do some advertising because there are likely some children we’re missing,” she said. “We want to service local and statewide communities as best we can. If more blood clots are happening nationally, there are probably more happening locally, and we want to be positioned to help these children.”