Evaluation for inherited and acquired prothrombotic defects predisposing to symptomatic thromboembolism in children with acute lymphoblastic leukemia: a protocol for a prospective, observational, cohort study

Table 2 Definition of symptomatic TE and preferred diagnostic evaluation

	Site	Likely clinical signs and symptoms	Diagnostic method/s
CNS	Arterial ischemic stroke +/− hemorrhage	Unexplained headaches, vomiting, visual problems, or neurological deficits, seizure, drowsiness or any change in mental status	MRI/MRA Angiogram
CNS	Sinovenous thrombosis (SVT)		MRI /MRV CT venogram
PE	Pulmonary vasculature	Respiratory problems (shortness of breath, tachypnea, dyspnea) hypoxia, chest pain, syncope “Unexplained pneumonia”	V/Q scan Spiral CT Pulmonary angiogram
DVT	Upper venous system	Swelling, pain, tenderness, erythema, dilated vessels	Bilateral venogram is “gold standard” for diagnosis especially for subclavian/brachial vessels ^aDoppler USG sufficient for jugular vein MRV Recommend ECHO to evaluate RA
DVT	Lower venous system	Swelling, pain, tenderness, erythema, dilated vessels	^aDoppler USG to evaluate all sites Venogram is still the gold standard
Cardiac	Right atrial (RA)	CVL malfunction, sepsis, congestive heart failure	ECHO
CVL related	Asymptomatic CVL tip thrombi ONLY if the catheter tip is in RA	-	ECHO Linogram Venogram
CVL related	Only symptomatic CVL TE will be considered significant	Swelling, pain, tenderness, erythema, dilated vessels, CVL malfunction requiring revision or renewal, headache, swelling of face	Linogram +/− venogram &/or ^aDoppler USG depending upon the site of thrombosis

In the presence of TE at one site recommend evaluating other sites (especially if anatomically related e.g. jugular vessels in presence of SVT) for associated asymptomatic TE, if possible
TE thromboembolism, CNS central nervous system, MRI Magnetic resonance imaging, MRV Magnetic resonance venogram, MRA Magnetic resonance arteriogram, PE pulmonary embolism, V/Q scan ventilation/perfusion scan CT computerized tomogram, DVT deep venous thrombosis, USG ultrasonogram, CVL central venous line
^aDetection of echogenic material within the lumen of a vein on a gray scale and presence of partial or complete absence of flow by pulse wave or color Doppler ultrasonography

ISSN: 1471-2407