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Year :2023
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Month :
October
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Volume :
11
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Issue :
4
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Page :
PC03 - PC05
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Isolated Protein S Deficiency Presenting in Neonatal Inferior Vena Cava as Right Atrial Thrombus: A Case Report
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Correspondence Address :
Amritha Vinod, Karthikeyan Kadirvel, Amirtha Ganesh, V Premnath,
Dr. Amritha Vinod,
Junior Resident, Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry-607402, India.
E-mail: amrita.arona22@gmail.com
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Critically ill neonates are at the greatest risk of developing thromboembolic disease. Multiple risk factors have been identified, one of which is isolated Protein S deficiency-a rare cause. The free form of Protein S plays a role in anticoagulation, and its deficiency can manifest as deep venous thrombosis, pulmonary emboli, and superficial thrombophlebitis. Hereby, the authors present a case report of a two-day-old female neonate, born to a gestational diabetic mother, who was initially managed for hypoglycaemia and polycythaemia. On day 4 of life, the baby was shifted to the mother’s side. Twenty-four hours later, she developed late-onset neonatal sepsis with disseminated intravascular coagulation and required management with a mechanical ventilator, Intravenous (IV) antibiotics, and inotropic support. Echocardiography (ECHO) revealed a thrombus (8.9×6.8 mm) attached to the septum of the right atrium, extending from the Inferior Vena Cava (IVC). Treatment with Low Molecular Weight Heparin (LMWH) was initiated, and a follow-up ECHO after three months showed complete resolution of the thrombus. Interval analysis revealed isolated Protein S deficiency with normal Protein C levels. The present report emphasises the importance of interval analysis in identifying causes of Neonatal Thrombotic Events (NTE). Early diagnosis and management can reduce associated morbidity and mortality.
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