The coagulopathy of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well documented in adults, with increases in D-dimer and prothrombin time found to be strong predictors of mortality, and anticoagulation shown to decrease this mortality. Viscoelastic parameters such as elevations in maximum clot firmness (MCF) on rotational thromboelastometry (ROTEM) have correlated with a hypercoagulable state in adults with SARS-CoV-2. We report our experience in children infected with SARS-CoV-2, with noted elevations in D-dimer and MCF on ROTEM (indicating hypercoagulability). Exploration of viscoelastic testing to provide additional laboratory-based evidence for pediatric-specific risk assessment for thromboprophylaxis in SARS-CoV-2 is warranted.

Background Adults infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have had high rates of thrombosis. A novel condition in children infected with SARS‐CoV‐2, multisystem inflammatory syndrome in children (MIS‐C), has limited data on their prothrombotic state or need for thromboprophylaxis. Objectives We aimed to analyze the prothrombotic state using coagulation profiles, rotational thromboelastometry (ROTEM) parameters and clinical outcomes, to determine if this could aid in risk stratification for thromboprophylaxis. Methods This analysis included patients (<21 years of age) with a diagnosis of MIS‐C (n = 40) and controls (presenting with suspicion of MIS‐C but later ruled out; n = 26). Results MIS‐C patients had higher levels of inflammatory markers including D‐dimer (p < .0001), compared with controls, along with evidence of hypercoagulability on ROTEM with elevated evaluation of fibrinogen activity (FIBTEM) maximum clot firmness (MCF) (p < .05). For MIS‐C patients with D‐dimers >1000 ng/ml, there was a significant correlation of FIBTEM MCF (p < .0001) with a mean value of 37.4 (standard deviation 5.1). D‐dimer >2144 ng/ml was predictive of intensive care unit admission (area under the curve [AUC] 0.80; 95% confidence interval, 0.60–0.99; p < .01; sensitivity: 82%, specificity: 75%), and elevated FIBTEM MCF (AUC 1 for >2500 ng/ml). MIS‐C patients (50%) received enoxaparin thromboprophylaxis (in addition to aspirin) with significant improvement in their inflammatory and ROTEM parameters upon outpatient follow‐up; none developed symptomatic thrombosis. Conclusions Despite an observed prothrombotic state, none of the MIS‐C patients (on aspirin alone or in combination with enoxaparin) developed symptomatic thrombosis. ROTEM, in addition to coagulation profiles, may be helpful to tailor thromboprophylaxis in critically ill MIS‐C patients.

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Multisystem inflammatory syndrome in children (MIS-C) affects few children previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In 2020, 45 children admitted to our hospital for MIS-C underwent genetic screening with a commercial 109-immune-gene panel. Thirty-nine children were diagnosed with MIS-C, and 25.4% of the 39 MIS-C patients harbored rare heterozygous missense mutations either in primary hemophagocytic lymphohistiocytosis (pHLH) genes (LYST, STXBP2, PRF1, UNC13D, AP3B1) or the HLH-associated gene DOCK8 (four variants). We demonstrate that foamy virus introduction of cDNA for the four DOCK8 variants into human NK-92 natural killer (NK) cells led to decreased CD107a expression (degranulation) and decreased NK cell lytic function in vitro for each variant. Heterozygous carriers of missense mutations in pHLH genes and DOCK8 may serve as risk factors for development of MIS-C among children previously infected with SARS-CoV-2.

The coagulopathy of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well documented in adults, with increases in D-dimer and prothrombin time strong predictors of mortality and anticoagulation shown to decrease this mortality. Viscoelastic parameters such as elevations in maximum clot firmness (MCF) on rotational thromboelastometry (ROTEM) have correlated with a hypercoagulable state in adults with SARS-CoV-2. We report our experience in children infected with SARS-CoV-2, with noted elevations in D-dimer and MCF on ROTEM (indicating hypercoagulability). Exploration of viscoelastic testing to provide additional laboratory-based evidence for pediatric-specific risk-assessment for thromboprophylaxis in SARS-CoV-2 is warranted.

Background: Although the safety and therapeutic efficacy of COVID-19 convalescent plasma (CCP) has been extensively evaluated, the safety of CCP donation has not been explored in a multi-institutional context.Study design and methods: Nine blood collection organizations (BCOs) participated in a multi-institutional donor hemovigilance effort to assess the safety of CCP donation. Donor adverse events (DAEs) were defined according to the Standard for Surveillance of Complications Related to Blood Donation, and severity was assessed using the severity grading tool. Multivariate analysis was performed to determine attributes associated with DAE severity. Results: The overall DAE rate was 37.7 per 1000 donations. Repeat apheresis and apheresis-naïve donors experienced adverse event rates of 19.9 and 49.8 per 1000 donations, respectively. Female donors contributed 51.9% of CCP donations with a DAE rate of 49.4 per 1000 donations. The DAE rate for male donors was 27.4 per 1000 donations. Vasovagal reactions accounted for over half of all reported DAEs (51.1%). After adjustment, volume of CCP donated was associated with vasovagal reaction severity (odds ratio [OR] 6.5, 95% confidence interval [CI] 2.5-17.1). Donor age and donation history were also associated with DAE severity. Considerable differences in DAE types and rates were observed across the participating BCOs despite the use of standardized hemovigilance definitions. Conclusion:The safety of CCP donation appears comparable to that of conventional apheresis plasma donation with similar associated risk factors for DAE types and severity.

Prolonged prothrombin time (PT) and/or activated partial thromboplastin time (aPTT) are frequently seen in newly diagnosed paediatric leukaemia patients (NDPLP), which can lead to delayed diagnostic and therapeutic procedures due to concern for bleeding. A single-centre retrospective chart review of NDPLP between 2015 and 2018 aged 1-21 years. We analysed 93 NDPLP of whom 33.3% had bleeding symptoms within 30 days of presentation, predominantly mucosal bleeding (80.6%) and petechiae (64.5%). Median laboratory values: white blood cell count 15.7, haemoglobin 8.1, platelets 64, PT 13.2 and a PTT 31. Red blood cells were administered in 41.2%, platelets in 52.9%, fresh frozen plasma in 7.8% and vitamin K in 21.6% of patients. Prolonged PT was found in 54.8% of patients, while aPTT was prolonged in 5.4%. Anaemia and thrombocytopenia did not correlate with prolonged PT (P U 0.73 and P U 0.18, respectively), or prolonged aPTT (P U 0.52 and 0.42). Leukocytosis showed significant correlation with elevated PT (P < 0.001), but not aPTT (P U 0.3). Bleeding symptoms upon presentation did not correlate with prolonged PT (P U 0.83), prolonged aPTT (P U 1) or anaemia (P U 0.06) but had a significant correlation with thrombocytopenia (P< -0.0001).Therefore, a prolonged PT in NDPLP may not necessitate the reflexive use of blood product replacement, in the absence of significant bleeding, which is likely related to leukocytosis than to a true coagulopathy. Blood Coagul Fibrinolysis 34:152-155

Background and Objectives: It is well established from the European and North American literature that migration has a great impact on the mental health of the migrant population. The Gulf Cooperation Council (GCC) states are home to more than 13 million non-nationals, yet the mental health status and psychological well-being of this large population has rarely been investigated. The majority of migrants are blue collar or domestic workers coming from the Indian subcontinent and southeast Asia. There are isolated reports of psychosis and/or suicide among this 'at risk' population, but no reliable data are available. For this reason, we decided to conduct a systematic search of the literature to review the epidemiology and characteristics of the mental health issues of the migrant workers in the GCC countries. Methods: The literature search was conducted in both English and Arabic. The English search consisted of various words and combinations including migrant worker, domestic worker, mental health, Middle East, GCC countries and the six countries contributing the majority of the migrants to the GCC (India, Pakistan, Nepal, Sri Lanka, Philippines, and Indonesia). The search was conducted mainly in databases for academic journal articles such as PubMed, Scopus, PsycInfo and Google Scholar. Also, for each of the six migrant countries of origin identified, a search through the country's own medical and psychiatric journals was performed. The Arabic search was carried out on ArabPsyNet.com using the aforementioned combinations in the English literature. Results: Our literature search revealed very little regarding the mental health of migrant workers in GCC countries. The available literature consisted mostly of theoretical presentations or isolated clinical reports. There was a suggestion of an increased rate of psychosis and suicidal attempts. Vey few systematic and/or quantitative studies have ever been published. We therefore present a series of brief clinical vignettes to illustrate the scope of the problem. Conclusion: The lack of available published data regarding the mental health status of migrant workers in the GCC countries is somewhat surprising. We discuss possible reasons for underreporting and present steps to be taken to address this important issue.