All children with COVID-19 may have blood vessel damage, study shows

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In a new study, researchers found increased levels of a biomarker related to blood vessel damage in children with SARS-CoV-2 infection, even if the children had minimal or no symptoms of COVID-19.

They also found that a high proportion of children with COVID-19 infection met clinical and diagnostic criteria for thrombotic microangiopathy (TMA).

TMA is a syndrome that involves clotting in the small blood vessels and has been identified as a potential cause for severe COVID-19 in adults.

The research was conducted by a team at the Children’s Hospital of Philadelphia (CHOP).

Most children infected with COVID-19 have mild or minimal symptoms, although a small proportion develops severe disease or Multisystem Inflammatory Syndrome in Children (MIS-C), a post-viral inflammatory response to COVID-19.

Researchers have identified TMA as a potential cause for severe manifestations of COVID-19 in adults. However, the role of complement-mediated TMA has not been studied in children.

In the study, the team analyzed 50 children patients hospitalized at CHOP with COVID-19 infection.

Of those 50 patients, 21 had minimal COVID-19, 11 had severe COVID-19, and 18 were diagnosed with MIS-C.

The researchers tested a biomarker C5b9 for complement activation and TMA.

They found elevations of C5b9 in children with severe COVID-19 and MIS-C, but to their surprise, they also found that C5b9 was elevated in patients with minimal or asymptomatic disease.

Although most children with COVID-19 do not have severe disease, this study shows that there may be other effects of SARS-CoV-2 that are worthy of a test.

Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences.

The most important takeaway from this study is doctors have more to learn about SARS-CoV-2. They should not make guesses about the short and long-term impact of infection.

One author of the study is David T. Teachey, MD, an attending physician.

The study is published in Blood Advances.

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