# Two cases of venous thromboembolism in siblings after splenectomy due to a novel PROC gene mutation

## TL;DR

Two siblings developed blood clots after splenectomy due to a new mutation in the PROC gene, which causes low protein C activity.

## Contribution

A novel heterozygous mutation in the PROC gene is reported for the first time in a family with childhood venous thromboembolism.

## Key findings

- Both siblings had low PC activity and developed venous thrombosis after splenectomy.
- A novel PROC gene mutation (1204 A > G) was identified through Sanger sequencing.
- The mother was asymptomatic but carried the same heterozygous mutation.

## Abstract

Venous thromboembolism(VTE)is a common multifactorial disease. Anticoagulant protein deficiency is the most usual hereditary thrombophilia in the Chinese people, which includes protein C(PC), protein S and antithrombin deficiencies.

A retrospective analysis was conducted on clinical manifestations, laboratory tests, genetic information, and other relevant data of siblings diagnosed with VTE in 2020 at the Department of Pediatrics of Shenzhen Second People’s Hospital. The proband, a 12-year-old female, was admitted to the hospital in December 2020 with a complaint of pain in the left lower limb for four days. The examination found that the PC activity was 53%, and B-ultrasound showed bilateral thrombosis of the great saphenous vein in the thigh segment. The proband’s younger brother, a 10-year-old male, was admitted to the hospital in January 2021 due to right lower limb pain for two weeks. PC activity is 40%. B-ultrasound showed superficial venous thrombosis in the left lower limb and upper limb. Both siblings suffered from thalassemia and underwent splenectomy before recurrent thrombosis occurred. The proband’s mother was asymptomatic, and her PC activity was 45%. Both cases were treated with warfarin anticoagulation, and their symptoms improved. The proband’s mother was found to have a heterozygous mutation at this locus through Sanger sequencing.

Protein C deficiency should be considered for venous thromboembolism in childhood. The heterozygous mutation 1204 A > G in PROC exon 9 in this family is reported for the first time.