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\begin{document}

\title{Hematologic manifestations of SARS-CoV-2 infection and MIS-C in
hospitalized children. Results of the PICNIC registry.}



\author[1]{Sarah Tehseen}%
\author[2]{Suzan Williams}%
\author[3]{Joan Robinson}%
\author[2]{Shaun Morris}%
\author[2]{Tala Tal}%
\author[2]{Ari Bitnun}%
\author[2]{Peter Gill}%
\author[2]{Ann Yeh}%
\author[4]{Carmen Yea}%
\author[5]{Helena Brenes-Chacon}%
\author[5]{Adriana Yock-Corrales}%
\author[5]{Rolando Ulloa-Gutierrez}%
\author[5]{Gabriela Ivankovich-Escoto}%
\author[5]{Alejandra Soriano-Fallas}%
\author[6]{Jesse Papenburg}%
\author[6]{Marie-Astrid Lefebvre}%
\author[6]{Rosie Scuccimarri}%
\author[7]{Alireza Nateghian}%
\author[7]{Behzad Aski}%
\author[8]{Rachel Dwilow}%
\author[8]{Jared Bullard}%
\author[9]{Leo Restivo}%
\author[9]{Suzette Cooke}%
\author[10]{Alison Lopez}%
\author[10]{Ashley Roberts}%
\author[11]{Manish Sadarangani}%
\author[12]{Michelle Barton Forbes}%
\author[13]{Nicole Saux}%
\author[13]{Jennifer Bowes}%
\author[1]{Rupeena Purewal}%
\author[14]{Janell Lautermilch}%
\author[15]{Ann Bayliss}%
\author[16]{Jacqueline Wong}%
\author[17]{Kirk Leifso}%
\author[18]{Cheryl Foo}%
\author[19]{Luc Panetta}%
\author[19]{Fatima Kakkar}%
\author[20]{Dominique Piche}%
\author[21]{Isabelle Viel-Theriault}%
\author[22]{Joanna Merckx}%
\author[23]{Lani Lieberman}%
\affil[1]{University of Saskatchewan}%
\affil[2]{The Hospital for Sick Children}%
\affil[3]{University of Alberta}%
\affil[4]{SickKids Research Institute}%
\affil[5]{Hospital Nacional de Ninos Dr Carlos Saenz Herrera}%
\affil[6]{McGill University Faculty of Medicine}%
\affil[7]{Iran University of Medical Sciences}%
\affil[8]{University of Manitoba Faculty of Health Sciences}%
\affil[9]{University of Calgary Faculty of Medicine}%
\affil[10]{The University of British Columbia Faculty of Medicine}%
\affil[11]{BC Children's Hospital Research Institute}%
\affil[12]{London Health Sciences Centre Children's Hospital}%
\affil[13]{University of Ottawa Faculty of Medicine}%
\affil[14]{University of Saskatchewan College of Medicine}%
\affil[15]{Trillium Health Partners}%
\affil[16]{McMaster University Faculty of Health Sciences}%
\affil[17]{Queen's University}%
\affil[18]{Memorial University of Newfoundland}%
\affil[19]{University of Montreal Faculty of Medicine}%
\affil[20]{Dalhousie University Faculty of Medicine}%
\affil[21]{Laval University Faculty of Medicine}%
\affil[22]{McGill University Faculty of Medicine and Health Sciences}%
\affil[23]{University Health Network}%


\vspace{-1em}



  
  \date{June 16, 2024}


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\selectlanguage{english}
\begin{abstract}
Introduction: Hematologic complications of SARS-CoV-2 infection are well
described in hospitalized adults with correlation to adverse outcomes.
Information published in children has been limited. Methods: An
international multi-centered retrospective registry was established to
collect data on the clinical manifestations of SARS-CoV-2 or multisystem
inflammatory syndrome (MIS-C) in hospitalized children between February
1, 2020 -- May 31, 2021. This sub-study focused on hematologic
manifestations. Study variables included patient demographics,
comorbidities, clinical presentation, course, laboratory parameters,
management, and outcomes. Results: Nine hundred and eighty-five children
were enrolled and 915 (93\%) had clinical information available; 385
(42\%) had symptomatic SARS-CoV-2 infection upon admission, 288 had
MIS-C (31.4\%) and 242 (26.4\%) had alternate diagnosis with SARS-CoV-2
identified incidentally. During hospitalization, 10 children (1\%)
experienced a thrombotic event, 16 (1.7\%) had hemorrhage and 2 (0.2\%)
had both thrombotic and hemorrhagic episodes. Significant prothrombotic
comorbidities included congenital heart disease (p-value = 0.007),
central venous catheter (p = 0.04) in children with primary SARS-CoV-2
infection; and obesity (p-value= 0.002), cytokine storm (p= 0.012) in
those with MIS-C. Significant pro- hemorrhagic conditions included age
\textgreater{} 10 years (p = 0.04), CVC (p= 0.03) in children with
primary SARS-CoV-2infection; and thrombocytopenia (0.001), cytokine
storm (0.02) in those with MIS-C. Eleven patients died (1.2 \%) with no
deaths attributed to thrombosis or hemorrhage Conclusion: Thrombotic and
hemorrhagic complications are uncommon in children with SARS-CoV-2
infection and observed with underlying co-morbid conditions.
Understanding the complete spectrum of hematologic complications in
children with SARS-CoV-2 infection or MIS-C requires ongoing
multi-center studies.%
\end{abstract}%



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