A New Model of Care: A Combined Pediatric/ Adult Thrombosis and Hemostasis (PATH) Clinic – One Center's Experience.

Patients of all ages with thrombosis are frequently tested for heritable thrombophilias (HT). Similarly, patients with bleeding or bruising may be tested for heritable bleeding (HB) conditions. We developed the Pediatric/Adult Thrombosis & Hemostasis (PATH) Clinic, a once-monthly clinic where children, adults and their families in whom the diagnosis of HT or HB was established or being considered could be assessed simultaneously by a pediatric and “adult” hematologist. Reasons for the clinic's creation included 1. HT/ HB conditions are lifelong. A combined clinic aids transition from a pediatric provider to an internist at the same institution. 2. Adolescence is when many HT/ HB disorders manifest themselves. This group has medical and developmental traits that cross pediatric and internal medicine approaches and expertise. 3. Adult experience. Much treatment for pediatric thromboses is extrapolated from adult data. An adult hematologist present at the evaluation of a pediatric patient with HT provides a valuable resource for the child and pediatric hematologist. 4. The finding of HT or HB in a patient has implications for family members regardless of age. 5. Convenience. All family members can be evaluated at a single visit where several members might need screening.

To review the experience of a combined pediatric/adult clinic created to evaluate potential HT/ HB in patients of all ages.

IRB-approved chart review.

92 patients have been evaluated (61 for HT, 31 HB). Mean age 18 yr., median 16 yr. Female 64%. The most common reason for referral was evaluation of HT in an asymptomatic patient (42%) because of a family member having had a thrombosis or recent diagnosis of HT. Those evaluated for potential HT were less likely to be symptomatic (i.e. had not experienced a thrombosis) than those with HB (31% vs. 65%, p < 0.01). Adolescents (13–21 yr old) comprised 52% of all patients (57% of all females). Adolescents were more likely to be referred for HT than other ages (75% vs. 56%, p < 0.01).

The model of the PATH clinic – simultaneous evaluation of patients of all ages with or suspicion for HT/ HB by a pediatric and “adult” hematologist – may be useful to other centers. Adolescents (in transition from the pediatric to adult age group) comprised the single largest cohort, emphasizing the potential importance of a combined approach. Adolescent women were especially represented, likely due to the new potential for bleeding (menarche) leading to a diagnosis of an HB and the emergence of acquired thrombophilic risk factors (estrogen contraception and pregnancy) in this group that have implications in families with HT. Physicians in such a clinic should have particular knowledge of bleeding and thrombophilic conditions in adolescent women and of counseling for asymptomatic HT.

No relevant conflicts of interest to declare.