INITIAL CHANGES IN BLOOD TESTS IN CHILDREN WITH LOW-FLOW VASCULAR MALFORMATIONS OF THE MAXILLOFACIAL AREA
DOI:
https://doi.org/10.35220/2523-420X/2024.2.6Keywords:
vascular malformation, maxillofacial area, blood test parameters, coagulation tests, D-dimerAbstract
Purpose of the study. Promising conservative treatments for vascular malformations have emerged in recent years. The safety and efficacy of their use in complex vascular malformations are increasingly being evaluated. As an indicator of a violation of the general condition, the initial blood value level is important for preparing the patient for treatment and its control. The study aimed to analyze the initial blood values in children with lowflow vascular malformations and their correlation with malformation volume. Research methods. A retrospective analysis of 49 case histories of patients: 29 with venous malformation (VM), 20 with lymphatic malformation (LM), and compared them to a control group. The age range of patients was 1 to 18 years old. The malformation volume was determined according to MRI data, the initial level of the general, biochemical blood test and the coagulogram were assessed and their comparison with the control group. Scientific novelty. The VM volume was 14,97 ± 7,8 сm3 (in the range 2,0 – 198,3 сm3), LМ – 17,06 ± 18,12 сm3 (in the range 2,0 – 176,7 сm3). The erythrocytes level in 14% (p<0.05), the lymphocytes level in 18% (p=0.301) of patients with VM and the erythrocytes level in 26% (p=0.019), the lymphocytes level in 26% (p=0.301) of patients with LM were increased of a general blood test analysis. A decrease in hemoglobin level is observed in 21% (p=0.462) of children with LM. The total bilirubin in 10,7% (p=0.698) (VM) and the creatinine in 10,5% (p=0.574) (LM) showed an increase according to the results of biochemical analysis. A decrease in total protein was found in 10,5% (p<0.05) of children with LM. The D-dimer in 28% (p<0.05), INR – 23,8%, APTT – 18% (p<0.01) were elevated of children with VM. All other blood parameters were within the normal range for the patient’s age. Spearman’s direct correlation was found between the VM volume and the D-dimer index (p<0.05). There were no significant changes observed in the coagulogram indicators of children with LM. Conclusions. When preparing the patient for treatment, it is crucial to monitor levels of erythrocytes, lymphocytes, total bilirubin, creatinine, and coagulation. The study shows a significant direct correlation between the volume of the VM and the level of D-dimer in the blood.
References
Mäkinen T, Boon LM, Vikkula M, Alitalo K. Lymphatic Malformations: Genetics, Mechanisms and Therapeutic Strategies. Circ Res. 2021 Jun 25;129(1):136-154. doi: 10.1161/CIRCRESAHA.121.318142.
Bouwman FCM, Verhoeven BH, Klein WM, Schultze Kool LJ, de Blaauw I. Congenital Vascular Malformations in Children: From Historical Perspective to a Multidisciplinary Approach in the Modern Era-A Comprehensive Review. Children (Basel). 2024 May 8;11(5):567. doi: 10.3390/children11050567.
Mack JM, Pierce CD, Richter GT, Spray BJ, Nicholas R, Lewis PS, Becton D, Crary SE. Analyzing coagulation dynamics during treatment of vascular malformations with thromboelastography. Pediatr Blood Cancer. 2021 Feb;68(2):e28824. doi: 10.1002/pbc.28824.
Crary SE, Mack JM. Anticoagulation and vascular anomalies. Res Pract Thromb Haemost. 2024 Apr 3;8(3):102402. doi: 10.1016/j.rpth.2024.102402.
Ni B, Liu JW, Fan XQ, He B, Nie QQ, Ye ZD, Liu P, Wen JY. Clinical outcomes and predictors of bleomycin polidocanol foam sclerotherapy treatment response in venous malformations. J Int Med Res. 2024 Jan;52(1):3000605231223441. doi: 10.1177/03000605231223441.
Mack, Joana M.a; DeHart, Austin N.b; Verkamp, Bethanyc; Lewis, P. Spencerd; Crary, Shelley E.a. Bleomycin Sclerotherapy Is Laboratory Monitoring Necessary? Journal of Vascular Anomalies 2(3):p e013, September 2021. doi: 10.1097/JOVA.0000000000000013
Бензар ІМ, Жумік ДВ. Інгібітори mTOR-рецепторів у комплексному лікуванні судинних мальформацій високого ризику у дітей. Хірургія дитячого віку. 2020 2(67): 6-13; doi 10.15574/PS.2020.67.6
Leboulanger N, Bisdorff A, Boccara O, Dompmartin A, Guibaud L, Labreze C, Lagier J, Lebrun-Vignes B, Herbreteau D, Joly A, Malloizel-Delaunay J, Martel A, Munck S, Saint-Aubin F, Maruani A. French national diagnosis and care protocol (PNDS, protocole national de diagnostic et de soins): cystic lymphatic malformations. Orphanet J Rare Dis. 2023 Jan 13;18(1):10. doi: 10.1186/s13023-022-02608-y.
Sharma S, Kumar S, Tewari P, Pande S, Murari M. Utility of thromboelastography versus routine coagulation tests for assessment of hypocoagulable state in patients undergoing cardiac bypass surgery. Ann Card Anaesth. 2018;21:151-157. doi: 10.4103/aca.ACA_174_17.
Aronniemi J, Långström S, Mattila KA, Mäkipernaa A, Salminen P, Pitkäranta A, Pekkola J, Lassila R. Venous Malformations and Blood Coagulation in Children. Children (Basel). 2021 Apr 20;8(4):312. doi: 10.3390/children8040312.
Ren JG, Xia HF, Yang JG, Zhu JY, Zhang W, Chen G, Zhao JH, Sun YF, Zhao YF. Down-regulation of polycystin in lymphatic malformations: possible role in the proliferation of lymphatic endothelial cells. Hum Pathol. 2017 Jul;65:231-238. doi: 10.1016/j.humpath.2017.05.016.
Seront E., Van Damme A., Legrand C., Bisdorff-Bresson A., Orcel P., Funck-Brentano T., Sevestre M.-A., Dompmartin A., Quere I., Brouillard P., et al. Preliminary results of the European multicentric phase III trial regarding sirolimus in slow-flow vascular malformations. JCI Insight. 2023;8:e173095. doi: 10.1172/jci.insight.173095
Liu H, Hu L, Yang X, Xu Z, Gu H, Chen H, Lin X. Dabigatran etexilate is efficacious in consumptive coagulopathy and pain associated with venous malformations. J Vasc Surg Venous Lymphat Disord. 2023 Mar;11(2):397-403.e1. doi: 10.1016/j.jvsv.2022.09.015.
Wagner K.M., Lokmic Z., Penington A.J. Prolonged antibiotic treatment for infected low flow vascular malformations. J. Pediatr. Surg. 2018;53:798–801. doi: 10.1016/j.jpedsurg.2017.05.022.
