Cancer & Blood Disorders Institute

Pediatric Thrombosis Program

Deep vein, arterial and venous thrombosis in children are treated with care at the Johns Hopkins All Children’s Cancer & Blood Disorders Institute. 

Your doctors and specialists at Johns Hopkins All Children's Hospital take a family-centered approach to dealing with pediatric thrombosis, making sure you are informed and involved in decision-making every step of the way. Our specialty program focuses on the treatment of thrombosis because even though clots often occur in children who have other underlying illnesses, the need for expert management of the blood clot and future risks should not be overlooked.

Clinical Expertise and Research Lead the Way

The Pediatric Thrombosis Program combines the expertise of Johns Hopkins All Children’s and Johns Hopkins Medicine to help children who have developed a blood clot in the veins (venous thrombosis) or arteries (arterial thrombosis). The program extends from inpatient to outpatient care, consultation and access to the latest research developments in treatment via leadership and participation in clinical trials.

Specific Conditions Treated

  • Deep vein thrombosis (DVT) of the arms, legs, pelvis or upper chest
  • Pulmonary embolism
  • Cerebral sinovenous thrombosis
  • Renal vein thrombosis
  • Hepatic vein or portal vein thrombosis
  • Jugular vein thrombosis, including Lemierre syndrome
  • Vena caval thrombosis
  • Family history of thrombosis before 50 years of age
  • Known inherited trait or acquired condition causing increased risk of thrombosis
  • Protein C, Protein S and Antithrombin deficiencies
  • Factor V Leiden and Prothrombin (factor II) variants
  • Antiphospholipid antibodies and antiphospholipid antibody syndrome
  • Elevated lipoprotein(a)

Services Offered

  • Hematological evaluation
  • Hypercoagulability (thrombophilia) testing and interpretation
  • Radiologic evaluation and interpretation: Doppler ultrasound, Magnetic resonance (MR) venography (MRV), MR arteriography (MRA), Computed tomography (CT) with venography (CTV), CT with arteriography (CTA), Conventional venography
  • Antithrombotic/anticoagulant ("blood thinner") medication prescription
  • Anticoagulant medication monitoring (including laboratory testing and warfarin dose-adjustment)
  • Thrombolytic ("clot buster") therapies
  • Chronic venous insufficiency (post-thrombotic syndrome) evaluation
  • Preventive medicine
  • Patient/family education
  • Second opinions
  • Local, national and international research (including clinical trials)

Why choose the Pediatric Thrombosis Program at Johns Hopkins All Children's Hospital?

Because of the rarity of thrombosis in children, few physicians have extensive experience in treating this problem and preventing short-term and long-term consequences. Our pediatric thrombosis doctors are internationally recognized as leaders in the research and management of pediatric thrombosis.

Dr. Neil Goldenberg, medical director of the program, and Dr. Irmel Ayala, medical director of the Hemophilia Treatment Center, have a collective experience of managing more than 1,000 pediatric thrombosis patients in the past 10 years. This experience, combined with their involvement in the latest national/international guidelines and clinical research studies, has allowed them to determine soon after the onset of thrombosis whether a child is at high- versus low-risk for the potential long-term complications, and to develop an individualized treatment and follow-up plan for each patient—in order to achieve the best outcomes.

Our pediatric thrombosis doctors have devoted their careers to caring for children who experience a blood clot and strive to provide the best possible outcomes for their patients.

For more information, call 727-767-4176.

Meet Your Multidisciplinary Team

The program is directed by Dr. Neil Goldenberg, who leads the pediatric thrombosis programs at Johns Hopkins All Children's and the Johns Hopkins Children’s Center in Baltimore.

The physician team also includes:

  • Dr. Irmel Ayala, who leads the Johns Hopkins All Children’s bleeding and clotting disorder clinics at the main hospital in St. Petersburg, Fla., and the subspecialty clinic in Tampa, Fla. as well as outreach clinics in Lakeland and Ft. Myers
  • Dr. Marisol Betensky, physician leader, Inpatient Hemostasis and Thrombosis Service, and Assistant Professor of Pediatrics at Johns Hopkins University School of Medicine
  • Dr. Paul Colombani, pediatric surgeon and Professor of Surgery at Johns Hopkins University School of Medicine
  • Dr. George Jallo, Director of the Institute for Brain Protection Sciences, Pediatric Neurosurgeon and Professor of Surgery at Johns Hopkins University School of Medicine
  • Dr. Gary Stapleton, co-director of the Heart Institute, division chief of Pediatric Cardiology and medical director of the Cardiac Catheterization Laboratory
  • Dr. Mark Bittles, pediatric interventional radiologist

Additionally, the program is supported by a pediatric nurse practitioner, pediatric clinical pharmacist, clinical research coordinator and a nurse coordinator.

Why is a multidisciplinary team of experts so important? 

Thrombosis in children can occur in the veins or arteries of the limbs, brain, lungs, heart, liver or kidneys, among other vital areas of the body. Optimal care of children with thrombosis therefore can require expertise not only from a pediatric hematologist who specializes in blood clots, but from a variety of pediatric specialties, including hematology, radiology, clinical coagulation laboratory, neurology, pulmonary medicine, cardiology, anticoagulant pharmacy, and others. 

In the inpatient setting (when children are first hospitalized with thrombosis), our multidisciplinary care team consists of:

  • Pediatric intensive care physicians and nurses
  • Pediatric hematologists
  • Pediatric radiologists
  • Pediatric anesthesiologists
  • Pharmacists
  • Child life specialists
  • Social workers
  • Discharge planners
  • Research personnel
  • Other specialists pertinent to the individual child’s condition and needs

In the outpatient setting, our multidisciplinary clinic involves:

  • Drs. Goldenberg, Betensky and Ayala as pediatric hematologists with specialized expertise in thrombosis
  • An anticoagulant (“blood thinner” medication) pharmacist
  • A pediatric thrombosis nurse
  • Research personnel
  • Coordinated visits with other subspecialists as appropriate to organ systems affected by the blood clot and any underlying chronic medical conditions
    For example:
    • Pediatric cardiologists, for children with congenital heart disease who have developed blood clots;
    • Pediatric neurologists, for children with blood clots in the cerebral venous system;
    • Pediatric oncologists, for children who have developed blood clots while undergoing treatment for cancer.
  • An expert pediatric physician-pharmacist team approach to outpatient dose-adjustment and monitoring.