Landyn's Story: A Child's Dramatic Battle Against Blood Clots
Family details patient's scary fight against thrombosis
As a nose tackle on his youth football team, Landyn Gray is a tough kid.
So when he complained that he “felt funny,” his parents took notice.
It was late in the summer, a few weeks before school, and Landyn was at football practice in Arlington, Texas. He was involved in a pileup during a play and someone accidentally stepped on his side.
Following practice, Landyn told his parents he didn’t feel well. When he got home, he went upstairs and threw up before going to bed. His family thought maybe it was the rough day of football or the way he guzzled water at the end of practice.
The next morning, Landyn’s father, Kirk, went to work. He’s a truck driver and had a delivery to make in Longview. Landyn’s stepmother, Angela, felt like she should stay home from work just in case it was something else.
“I got a call from my wife. Thank God she didn’t go to work that day,” Kirk said. “She told me Landyn had used the bathroom and when he peed, it was straight blood. It was black.”
Angela told Kirk she was going to take him to a nearby Arlington hospital. As she went upstairs to get Landyn, she was shocked at what she saw.
“He was throwing up everywhere,” Kirk said. “Landyn was projectile vomiting. I didn’t see the room right after, but my wife said it looked like a murder scene. She told me, ‘Baby you don’t want to see this.’ It was scary.”
At the hospital, Landyn complained of abdominal pain. His urinalysis looked like a cup of ink because the blood was so dark. Doctors ran an abdominal CT scan with contrast. It showed the renal vein thrombosis and inferior vena cava thrombosis: blood clots were occluding (obstructing) them.
“It was the scariest moment of my life,” Kirk said. “You’re the protector of your child and when something comes around and you are helpless … It was so scary.”
Adding to Kirk’s fear was Landyn’s family history. Landyn’s birth mother died as a result of clots in the lungs. But this was happening to an 11-year-old boy.
The doctors told the family that Landyn needed to be taken to Cook Children’s where they specialize in pediatrics. Landyn was rushed to the medical center in an ambulance with his father in the back.
Landyn was admitted to the Pediatric Intensive Care Unit at Cook Children’s and Hematology and Interventional Radiology were then brought in to treat the young patient.
The decision was to start heparin (blood thinner medication) overnight and to proceed with Interventional Radiology thrombolysis the following morning,” said Marcela Torres, M.D., a pediatric hematologist and co- medical director of the Stroke and Thrombosis Program at Cook Children's. She discussed the case with Adeka McIntosh, M.D., one of the interventional radiologists at Cook Children’s, and formulated a careful plan to treat Landyn.
Pediatric Interventional Radiology (IR) at Cook Children's offers minimally invasive, image-guided diagnoses, treatments and therapies designed especially for kids.
Thanks to advanced technologies, many disease and injury assessments and treatments no longer require invasive surgeries. Today, many of the diseases and injuries that once required extensive surgery can be treated with minimal risk, less pain and faster recovery times.
The team’s board certified interventional radiologists have extensive training in interventional radiology with specialization in the pediatric population. In addition, there is a team of nurses and technicians also specialized in intervention radiology procedures in pediatrics and even our equipment is designed to meet the needs of children.
While clots have been considered primarily an adult diagnosis, the doctors at Cook Children’s have seen an increase in pediatric thromboembolic events.
In certain thrombotic problems, blood thinners are not enough to treat the blood clots. When a blood clot affects the function of a vital organ, as in Landyn’s case, his kidney, a more aggressive intervention such as thrombolysis is indicated. Thrombolysis involves the use of a medication and/or a special catheter that are used to break up blood clots that restrict blood flow in veins or arteries.
Chemical thrombolysis is done using tissue plasminogen activator (tPA), a medication that will break up the clot. It can be given systemically by the hematologist through a simple peripheral intravenous catheter, or, in certain cases, it can be done through a catheter that the Interventional radiologist places in the vein or artery where the clot is located.
For mechanical thrombolysis a special catheter is used to break up and suction out the clot. The doctor performing the procedure guides a catheter (a thin tube) into the blood vessel (the vein or artery). Using live X-ray for guidance, the doctor will maneuver the catheter to the area where the clot has formed. The catheter can remain in the blood vessel for a few days depending on how quickly the blood clot is dissolving.
Landyn’s procedure lasted four days and he remained in the intensive care unit all that time. During the time the catheter stayed in the affected vessels, Dr Torres managed closely the use of blood thinners concurrently with the use of tPA (clot bursting medication) due to the high risk of bleeding complications. In Landyn’s case, it was very difficult due to the fact that he has urinating blood. Close team work between hematology and interventional radiology, is vital to manage these complicated patients.
The procedure was successful in Landyn’s case and most of the clot was gone by the time the catheters were removed. Landyn was transitioned to heparin (blood thinner), which was given intravenously and once his renal function improved and the bleeding stopped, he was transitioned to Lovenox (another type of blood thinner) which is given as an injection.
“These are some of my favorite cases to treat because we can, almost immediately, make a difference in the patients’ lives. This is as close to instant gratification as I get in my practice and I really love it,” Dr. McIntosh said.
After another week of that treatment, Landyn was discharged to go home on blood thinners and his family was taught about the risks and complications of blood thinners.
Landyn cannot compete again in full contact sports due to the use of blood thinners, but he is back to school and enjoying a full active life, playing in his band and able to participate in sports that do not involve full contact.
Given Landyn’s family history, an inherited condition was suspected. He was studied for the multiple conditions of the blood that can increase his risk for thrombosis. He was found to have Protein S deficiency. People with this condition have a greater risk of developing abnormal blood clots than most of us.
Landyn’s risk for having blood clots, will always be higher because of his inherited condition. Doctors say it’s extremely important for him to avoid situations that can increase his risk of developing blood clots even more, such as : Dehydration, prolonged immobilization, long surgeries (specially orthopedic procedures) obesity, long trips by car or plane (longer than four hours), smoking. His hematologist had told the family that it is probable that Landyn will need to be on blood thinners in the future or in specific situations with high risk for clotting.
A year later, Landyn is doing well. He’s followed doctors’ orders and is currently off all medication. It’s amazing all that’s happened during the course of a year in his young life.
“We can’t thank Cook Children’s enough,” Kirk said. “They saved Landyn’s life. They took care of him. That’s all we could ask. The doctors, nurses and everyone involved in Landyn’s care were top notch. They worked with him and for him. They worked with us too. They taught us ways to take care of him. We had to give him shots when he first got home. I’m afraid of needles. The fact that they helped me give him a shot, is unbelievable. A friend of mine has a grandson that lives outside of Fort Worth, I told him to bypass everyone and go to Fort Worth.”
Then with a laugh Kirk adds, “I’m a grown man and I wish I could go to Cook Children’s.”