PEG Asparginase Induced Superior Sagittal Sinus Thrombosis with Status Epilepticus Pediatric in Acute Lymphoblastic Leukemia (ALL): A Report of 2 Cases from India

摘要

Among all pediatric malignancies, acute lymphoblastic leukemic children are more prone for venous thrombosis, with an estimated incidence of 1-36% which includes both symptomatic and asymptomatic cases detected on screening. The risk of thrombosis is secondary to increased thrombin generation at the time of diagnosis combined with decreased clearance of thrombin secondary to PEG asparginase. This further gets aggravated by concomitant use of steroids in induction along with indwelling central venous catheters. Role of antithrombin concentrates and anticoagulants is still not in practice for primary prevention. For children who are at high risk of thrombosis, prophylactic fresh frozen plasma is recommended. Though central nervous system thrombosis, cerebral venous thrombosis is a known complication with L asparginase, none has been reported secondary to PEG asparginase from India. Here two cases of PEG asparginase induced Superior Sagittal Sinus Thrombosis (SSST) have been reported presenting with status epilepticus in Acute Lymphoblastic Leukemia (ALL) children described for the first time from India. Case 1 presented soon after induction and case 2 in third week of induction. Case 1 had low protein S and antithrombin which got normalised 3 months post episode and case 2 had normal thrombophilia work up. Both continued on further chemotherapy smoothly with concomitant usage of low molecular weight heparin at therapeutic dosage for 3 months and at prophylactic dosage until reinduction completion.