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Article ; Online: Sports participation in chronic immune thrombocytopenia: Safer than you thought?

Witmer, Char M / Lambert, Michele P

2023 Volume 70, Issue 12, Page(s) e30682

Abstract: Background/objectives: Pediatric patients with chronic immune thrombocytopenia (ITP) commonly have activity limitations placed to prevent injury without data guiding clinical decision-making. The objective of this study was to determine risk factors ... ...

Abstract	Background/objectives: Pediatric patients with chronic immune thrombocytopenia (ITP) commonly have activity limitations placed to prevent injury without data guiding clinical decision-making. The objective of this study was to determine risk factors associated with injury in children with chronic ITP. Design/methods: Retrospective single-center cohort study from January 1, 2008 to March 31, 2019 in subjects age 5-21 years with chronic ITP (platelet count < 100,000/µL for >1 year). Results: One-hundred-two subjects were included, with a mean diagnosis age of 9.3 ± 4.6 years. Mean follow-up 3.8 ± 2.3 years; 61% (62) of subjects were female; 60% (61) participated in organized sports, mean 2 ± 1 sports/subject; 8.8% (9) received ITP therapy for sports participation. Common sports: basketball (28%) and soccer (28%). There were 31 injuries in 26 subjects, and 68% (21) occurred while at play. Most common injuries: 68% (21/31) soft tissue and 23% (7/31) head trauma. Fifteen (48%) injuries were severe enough for medical evaluation at the time of injury. Only one patient received acute ITP treatment for their injury. Injury was associated with participation in high-risk sports (p < .001), male sex (p = .007), and participation in multiple organized sports (p = .008). Conclusion: In this study of 102 pediatric subjects with chronic ITP, injury was mild and infrequent predominantly occurring while at play. The majority participated in organized sports safely. Risk of injury was associated with high-risk sport participation (p < .001). Only one injury necessitated ITP treatment, suggesting that participation in most sports is likely safe in children with chronic ITP.
Language	English
Publishing date	2023-09-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2131448-2
ISSN	1545-5017 ; 1545-5009
ISSN (online)	1545-5017
ISSN	1545-5009
DOI	10.1002/pbc.30682
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Article ; Online: Recurrence of a high-titre factor VIII inhibitor in a haemophilia A patient on emicizumab prophylaxis.

Doshi, Bhavya S / Witmer, Char M

Haemophilia : the official journal of the World Federation of Hemophilia

2021 Volume 27, Issue 4, Page(s) e551–e553

MeSH term(s)	Antibodies, Bispecific/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Factor VIII ; Hemophilia A/drug therapy ; Humans
Chemical Substances	Antibodies, Bispecific ; Antibodies, Monoclonal, Humanized ; emicizumab (7NL2E3F6K3) ; Factor VIII (9001-27-8)
Language	English
Publishing date	2021-04-18
Publishing country	England
Document type	Letter
ZDB-ID	1229713-6
ISSN	1365-2516 ; 1351-8216 ; 1355-0691
ISSN (online)	1365-2516
ISSN	1351-8216 ; 1355-0691
DOI	10.1111/hae.14311
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Zs.A 4249: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: How I approach managing student athletes at risk for bleeding.

Witmer, Char M

Pediatric blood & cancer

2018 Volume 66, Issue 2, Page(s) e27523

Abstract: Frequently, pediatric hematologists need to provide guidance regarding sports participation for children with congenital coagulopathies, immune thrombocytopenia, and those receiving anticoagulation. Although sports participation has clear health and ... ...

Abstract	Frequently, pediatric hematologists need to provide guidance regarding sports participation for children with congenital coagulopathies, immune thrombocytopenia, and those receiving anticoagulation. Although sports participation has clear health and psychosocial benefits, it can be associated with harm secondary to bleeding from injury. Decision-making for sports involvement should be individualized, patient centered, and well informed. This review focuses on the current data regarding the benefit as well as risks for sports participation and provides a framework for advising and supporting the student athlete who is at risk for bleeding.
MeSH term(s)	Adolescent ; Athletes ; Blood Coagulation Disorders ; Child ; Female ; Hemorrhage/prevention & control ; Humans ; Male ; Sports ; Students
Language	English
Publishing date	2018-10-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2131448-2
ISSN	1545-5017 ; 1545-5009
ISSN (online)	1545-5017
ISSN	1545-5009
DOI	10.1002/pbc.27523
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Article ; Online: Treatment of venous thromboembolism in pediatric patients.

Witmer, Char / Raffini, Leslie

Blood

2020 Volume 135, Issue 5, Page(s) 335–343

Abstract: Venous thromboembolism (VTE) is rare in healthy children, but is an increasing problem in children with underlying medical conditions. Pediatric VTE encompasses a highly heterogenous population, with variation in age, thrombosis location, and underlying ... ...

Abstract	Venous thromboembolism (VTE) is rare in healthy children, but is an increasing problem in children with underlying medical conditions. Pediatric VTE encompasses a highly heterogenous population, with variation in age, thrombosis location, and underlying medical comorbidities. Evidence from pediatric clinical trials to guide treatment of VTE is lacking so treatment is often extrapolated from adult trials and expert consensus opinion. Aspects unique to children include developmental hemostasis and the major role of central venous access devices. There is an absence of information regarding the optimal target levels of anticoagulation for neonates and infants and lack of suitable drug formulations. Anticoagulants, primarily low-molecular-weight heparin and warfarin, are used to treat children with symptomatic VTE. These drugs have significant limitations, including the need for subcutaneous injections and frequent monitoring. Randomized clinical trials of direct oral anticoagulants in pediatric VTE are ongoing, with results anticipated soon. These trials will provide new evidence and options for therapy that have the potential to improve care. International collaborative registries offer the ability to study outcomes of rare subgroups of pediatric VTE (eg, renal vein thrombosis), and will be important to ultimately guide therapy in a more disease-specific manner.
MeSH term(s)	Anticoagulants/therapeutic use ; Child ; Exercise ; Hemorrhage/complications ; Humans ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/epidemiology
Chemical Substances	Anticoagulants
Language	English
Publishing date	2020-01-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood.2019001847
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Uh III Zs.140: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Outcomes in infants with unprovoked venous thromboembolism: A retrospective cohort study.

Whitworth, Hilary / Beslow, Lauren A / Hubbard, Rebecca A / Leonard, Charles E / Scobell, Rebecca / Witmer, Char / Raffini, Leslie

Research and practice in thrombosis and haemostasis

2023 Volume 7, Issue 4, Page(s) 100174

Abstract: Background: Although children aged <1 year have a relatively high rate of venous thromboembolism (VTE) compared to older children, most have additional prothrombotic risk factors. Unprovoked VTE is rare, and little is known about this population, ... ...

Abstract	Background: Although children aged <1 year have a relatively high rate of venous thromboembolism (VTE) compared to older children, most have additional prothrombotic risk factors. Unprovoked VTE is rare, and little is known about this population, particularly the risk of recurrent VTE. Objectives: We aimed to determine the rate of recurrent VTE in infants with prior unprovoked VTE and evaluate long-term, end-organ outcomes for infants with renal and intracranial vein thrombosis. Methods: Infants <1 year of age with an unprovoked VTE between 2003 and 2021 at a single institution were included. Time to recurrent event and anticoagulation duration were summarized using the Kaplan-Meier estimator. Neurologic outcomes were summarized with the pediatric stroke outcome measure for infants with cerebral sinovenous, medullary, or cortical vein thrombosis. Kidney outcomes were summarized with estimated glomerular filtration rates for infants with renal vein thrombosis. Anticoagulation was summarized. Results: Forty infants with intracranial, renal, portal, and extremity VTE met the inclusion criteria and were followed for a median of 4.7 years (IQR, 2.1-8.5). Most VTE events occurred during the first month of life. There was 1 recurrent event in 237 person-years of follow-up (incidence rate, 4 per 1000 [95% CI, 0.6-29.9] person-years). In outpatient follow-up, 40% of infants with intracranial thrombosis met criteria for moderate or severe neurologic outcomes and two-thirds of infants with a prior renal vein thrombosis had abnormal kidney function (estimated glomerular filtration rate < 90 mL/min/1.73 m Conclusion: There is a low rate of recurrent VTE but significant end-organ morbidity in infants with unprovoked VTE.
Language	English
Publishing date	2023-05-13
Publishing country	United States
Document type	Journal Article
ISSN	2475-0379
ISSN (online)	2475-0379
DOI	10.1016/j.rpth.2023.100174
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Article ; Online: The Continued Rise of Venous Thromboembolism Across US Children's Hospitals.

O'Brien, Sarah H / Stanek, Joseph R / Witmer, Char M / Raffini, Leslie

Pediatrics

2022 Volume 149, Issue 3

Abstract: Objectives: In 2009, a large multicenter study demonstrated that the rate of pediatric venous thromboembolism (VTE) across US children's hospitals had significantly increased from 2001 to 2007. The objective of this study was to evaluate the rate of ... ...

Abstract	Objectives: In 2009, a large multicenter study demonstrated that the rate of pediatric venous thromboembolism (VTE) across US children's hospitals had significantly increased from 2001 to 2007. The objective of this study was to evaluate the rate of pediatric VTE from 2008 to 2019 using similar methodology. Methods: A retrospective cohort study using the Pediatric Health Information System (PHIS) database. Subjects from birth to <18 years admitted from 2008 through 2019 who had an ICD-9-CM or ICD-10-CM code for VTE were included. Demographics, underling medical comorbidities and mortality were collected. VTE location and anticoagulation data during admission were extracted. Results: During the 12-year study period, there were 52 401 hospital admissions among 39 713 pediatric patients with a diagnosis of VTE. The VTE admission rate increased from 46 VTE cases per 10 000 admissions in 2008 to 106 VTE cases per 10 000 admissions in 2019, a 130% increase (P < .0001) in VTE events. The median age at admission was 6.1 years, and almost one-third (31.3%) of patients with VTE were in the adolescent age group (13-17 years). Most patients (78%) had an underlying chronic medical condition. Conclusions: The rate of VTE in hospitalized pediatric patients continues to increase from a 70% increase reported from 2001 to 2007 to the 130% increase from 2008 to 2019. These findings support the need for more effective VTE prevention strategies. Clinical trials focused on risk stratification and VTE prevention are needed.
MeSH term(s)	Adolescent ; Child ; Databases, Factual ; Hospitalization ; Hospitals, Pediatric ; Humans ; Retrospective Studies ; Risk Factors ; Venous Thromboembolism/epidemiology
Language	English
Publishing date	2022-02-08
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2021-054649
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Um IV Zs.131: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 357: Show issues

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Article ; Online: High rate of recurrent venous thromboembolism in children and adolescents with unprovoked venous thromboembolism.

Whitworth, Hilary / Clark, Helen Havens / Hubbard, Rebecca A / Witmer, Char / Leonard, Charles E / Raffini, Leslie

Journal of thrombosis and haemostasis : JTH

2022 Volume 21, Issue 1, Page(s) 47–56

Abstract: Background: Unprovoked venous thromboembolism (VTE) is rare in pediatrics. Current recommendations for anticoagulation duration after unprovoked VTE differ for pediatric and adult populations.: Objectives: This single-center, retrospective cohort ... ...

Abstract	Background: Unprovoked venous thromboembolism (VTE) is rare in pediatrics. Current recommendations for anticoagulation duration after unprovoked VTE differ for pediatric and adult populations. Objectives: This single-center, retrospective cohort study aimed to determine the incidence rate of recurrent VTE in children and adolescents with unprovoked VTE, evaluate the potential risk factors for recurrence, and describe the anticoagulation regimens and bleeding in this population. Methods: Children with an index, unprovoked VTE at the age of 1 to <21 years between 2003 and 2021 were included. The time to recurrent VTE and anticoagulation duration were summarized using Kaplan-Meier estimators. Clinical covariates were assessed for association with recurrence using stratified Kaplan-Meier curves and univariate Cox proportional hazards regression. Results: Eighty-five children met the inclusion criteria, and there were 26 recurrent events in 250 person-years of follow-up (incidence rate = 104 [95% CI, 71-153] per 1000 person-years). An age of ≥12 years at index VTE (hazard ratio [HR], 7.56; 95% CI, 1.60-35.83) and inherited thrombophilia (HR, 2.28; 95% CI, 1.05-4.95) were significantly associated with recurrent VTE. Female sex had a nonstatistically significant decreased hazard of recurrence (HR, 0.56; 95% CI, 0.25-1.27). Duration of anticoagulation was variable, with a median duration of 274 days (IQR, 101-2357) for outpatient therapeutic anticoagulation. Twelve of the 26 (46%) recurrent events occurred while anticoagulation was prescribed. Conclusion: The incidence rate of recurrent VTE in pediatric patients with a prior unprovoked VTE is high, particularly for adolescents and those with inherited thrombophilia. Therefore, future research should focus on the efficacy of prolonged anticoagulation for this population.
MeSH term(s)	Adult ; Humans ; Female ; Adolescent ; Child ; Infant ; Venous Thromboembolism/diagnosis ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/epidemiology ; Anticoagulants/therapeutic use ; Retrospective Studies ; Blood Coagulation ; Risk Factors ; Thrombophilia/complications ; Thrombophilia/diagnosis ; Thrombophilia/drug therapy ; Recurrence
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-12-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2112661-6
ISSN	1538-7836 ; 1538-7933
ISSN (online)	1538-7836
ISSN	1538-7933
DOI	10.1016/j.jtha.2022.11.031
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Zs.A 5805: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 295: Show issues

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Article ; Online: Hematologic manifestations of systemic disease (including iron deficiency, anemia of inflammation and DIC).

Witmer, Char M

Pediatric clinics of North America

2013 Volume 60, Issue 6, Page(s) 1337–1348

Abstract: A complete blood cell count (CBC) is a frequent test sent to aid in the diagnostic evaluation of ill patients. Not uncommonly hematologic abnormalities may be the first sign of an underlying systemic disorder. The astute clinician needs to understand how ...

Abstract	A complete blood cell count (CBC) is a frequent test sent to aid in the diagnostic evaluation of ill patients. Not uncommonly hematologic abnormalities may be the first sign of an underlying systemic disorder. The astute clinician needs to understand how systemic disease can affect the CBC to direct further diagnostic investigations. This article focuses on the 2 most common acquired anemias including iron deficiency and anemia of inflammation as well as disseminated intravascular coagulation.
MeSH term(s)	Anemia/diagnosis ; Anemia/drug therapy ; Anemia, Iron-Deficiency/blood ; Anemia, Iron-Deficiency/diagnosis ; Anemia, Iron-Deficiency/drug therapy ; Blood Cell Count ; Disseminated Intravascular Coagulation/diagnosis ; Disseminated Intravascular Coagulation/drug therapy ; Humans ; Inflammation
Language	English
Publishing date	2013-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215711-1
ISSN	1557-8240 ; 0031-3955
ISSN (online)	1557-8240
ISSN	0031-3955
DOI	10.1016/j.pcl.2013.08.012
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Article ; Online: Description of a national, multi-center registry of patients with sickle cell disease and SARS-CoV-2 infection: Data from the Pediatric COVID-19 United States Registry.

Dain, Aleksandra S / Diorio, Caroline / Fisher, Brian T / Hankins, Jane S / Witmer, Char M / Boustany, Mickael / Burton, Madeline / Ferrolino, Jose / Sadaf, Salma / Ross, Hailey S / Maron, Gabriela

Pediatric blood & cancer

2024 Volume 71, Issue 6, Page(s) e30909

Abstract: Children with sickle cell disease (SCD) are at risk of complications from viral infections, including SARS-CoV-2. We present the clinical characteristics and outcomes of pediatric patients with SCD from the Pediatric COVID-19 United States Registry who ... ...

Abstract	Children with sickle cell disease (SCD) are at risk of complications from viral infections, including SARS-CoV-2. We present the clinical characteristics and outcomes of pediatric patients with SCD from the Pediatric COVID-19 United States Registry who developed acute COVID-19 due to SARS-CoV-2 infection (n = 259) or multisystem inflammatory syndrome in children (MIS-C; n = 4). Nearly half of hospitalized children with SCD and SARS-CoV-2 infection required supplemental oxygen, though children with SCD had fewer intensive care (ICU) admissions compared to the general pediatric and immunocompromised populations. All registry patients with both SCD and MIS-C required ICU admission. Children with SCD are at risk of severe disease with SARS-CoV-2 infection, highlighting the importance of vaccination in this vulnerable population.
MeSH term(s)	Humans ; Anemia, Sickle Cell/complications ; Anemia, Sickle Cell/epidemiology ; Anemia, Sickle Cell/therapy ; COVID-19/epidemiology ; COVID-19/complications ; Registries ; Child ; Female ; Male ; Adolescent ; United States/epidemiology ; SARS-CoV-2 ; Child, Preschool ; Infant ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/etiology ; Hospitalization/statistics & numerical data
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2131448-2
ISSN	1545-5017 ; 1545-5009
ISSN (online)	1545-5017
ISSN	1545-5009
DOI	10.1002/pbc.30909
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Article: Pediatric Hospital Acquired Venous Thromboembolism.

Witmer, Char M / Takemoto, Clifford M

Frontiers in pediatrics

2017 Volume 5, Page(s) 198

Abstract: Pediatric hospital acquired venous thromboembolism (HA-VTE) is an increasing problem with an estimated increase from 5.3 events per 10,000 pediatric hospital admissions in the early 1990s to a current estimate of 30-58 events per 10,000 pediatric ... ...

Abstract	Pediatric hospital acquired venous thromboembolism (HA-VTE) is an increasing problem with an estimated increase from 5.3 events per 10,000 pediatric hospital admissions in the early 1990s to a current estimate of 30-58 events per 10,000 pediatric hospital admissions. Pediatric HA-VTE is associated with significant morbidity and mortality. The etiology is multifactorial but central venous catheters remain the predominant risk factor. Additional HA-VTE risk factors include both acquired (recent surgery, immobility, inflammation, and critical illness) and inherited risk factors. Questions remain regarding the most effective method to assess for HA-VTE risk in hospitalized pediatric patients and what preventative strategies should be implemented. While several risk-assessment models have been published in pediatric patients, these studies have limited power due to small sample size and require prospective validation. Potential thromboprophylactic measures include mechanical and pharmacologic methods both of which have associated harms, the most significant of which is bleeding from anticoagulation. Standard anticoagulation options in pediatric patients currently include unfractionated heparin, low molecular weight heparin, or warfarin all of which pose a monitoring burden. Ongoing pediatric studies with direct oral anticoagulants could potentially revolutionize the prevention and treatment of pediatric thrombosis with the possibility of a convenient route of administration and no requirement for monitoring. Further studies assessing clinical outcomes of venous thromboembolism (VTE) prevention strategies are critical to evaluate the effectiveness and harm of prophylactic interventions in children. Despite HA-VTE prevention efforts, thrombotic events can still occur, and it is important that clinicians have a high clinical suspicion to ensure prompt diagnosis and treatment to prevent further associated harms.
Language	English
Publishing date	2017-09-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2017.00198
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