Farklı Trombositopeni Sebeplerinin Klinik ve Laboratuvar Bulguları

Yıl 2017, Cilt: 7 Sayı: 4, 316 - 322, 04.12.2017

Serkan Akın Şafak Akın Tülay Karaağaç Akyol İbrahim Haznedaroğlu

https://doi.org/10.16899/gopctd.360762

Öz

Amaç: Trombositopeni önemli bir kanama nedenidir. Bu çalışmada farklı nedenlere bağlı trombositopeniler ve onların hemostatik tabloya klinik ve laboratuar açısından yansımaları irdelenmiştir.

Metod: Çalışmaya 1993 ile 2011 yılları arasında Hacetttepe Üniversitesi Erişkin Hematoloji Bölümü’nde takip edilen 29 trombotik trombositopenik purpura (TTP), 36 immün trombositopenik purpura (ITP) ve 35 aplastik anemi (AA) hastası olmak üzere toplam 100 trombositopenik hasta dâhil edildi. Klinik özellikler ve laboratuvar sonuçları değerlendirildi.

Sonuçlar: Hastaların ortalama yaşları TTP grubunda 42.2 ± 19.5 yıl, ITP grubunda 40.1 ± 16.3 yıl ve AA grubunda 34.4 ± 14.7 yıl idi. AA grubunda kadın erkek oranı benzer iken TTP ve ITP grubunda kadınlar çoğunlukta idi.  Tromboz, ateş ve sepsis TTP hastalarında daha fazla izlenirken, kanama ise tüm AA hastalarında izlendi. Tüm hasta gruplarında en fazla derialtı kanaması görüldü. TTP hastalarının tümünde mikroanjiyopatik hemolitik anemi (MAHA) ve trombositopeni mevcut iken 25 (%86.2) hastada ateş, 26 (%89.7) hastada nörolojik bozukluk, 16 (%55.1) hastada ise böbrek fonksiyonlarında bozukluk görüldü. TTP tanısı koyarken 5 kriteri de sağlayan 13 (%44.8) hasta; 4 kriteri sağlayan 12 (%41.4) hasta; 3 kriteri sağlayan 4 (%13.8) hasta bulunmaktaydı. 

Sonuç: Trombositopenili hastaya yaklaşımda en önemli noktalar başvuru anındaki klinik ciddiyet ve altta yatan hastalıklardır.  Trombositopeninin nedenini saptamada klinik yansımalar yardımcı olmakla beraber tanı koydurmakta yeterli değildir.

Anahtar Kelimeler

Trombotik Trombositopenik Purpura, İmmün Trombositopeni, Kazanılmış Aplastik Anemi, Trombositopeni

Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia

Öz

Aim: Thrombocytopenia is an important cause of bleeding. Different clinical conditions associated with thrombocytopenia and their reflections to the hemostatic table will be examined in this study. 

Methods: A total of 100 patients with thrombocytopenia who were treated in Hacettepe University between 1993 and 2011, 29 with thrombotic thrombocytopenic purpura (TTP), 36 with immune thrombocytopenic purpura (ITP), and 35 with aplastic anemia (AA), were included in the study. Clinical features and laboratory values were reviewed. 

Results: The median ages were 42.2 ± 19.5 years, 40.1 ± 16.3 years, and 34.4 ± 14.7 years in patients with TTP, ITP, and AA, respectively. The majority of patients were female in the TTP and ITP groups, but the female to male ratio was nearly equal in the AA group. Thrombosis, fever, and sepsis were more frequently seen in TTP. The most common bleeding type was subcutaneous bleeding in all patient groups. Among patients with TTP, twenty-five patients (86, 2%) had fever, 26 patients (89, 7%) had a neurologic disorder, and 16 patients (55, 1%) had renal dysfunction. Regarding the diagnostic criteria of TTP, 13 patients (44, 8%) met five, 12 (41, 4%) patients met four and 4 (13, 8%) patients met three criteria. 

Conclusion: The severity of clinical presentation and underlying disorders are the most important points with which to approach patients with thrombocytopenia. Clinical reflections may help to identify the cause of thrombocytopenia but not sufficiently demonstrative for diagnosis.   

Anahtar Kelimeler

Thrombotic Thrombocytopenic Purpura, Immune Thrombocytopenia, Acquired Aplastic Anemia, Thrombocytopenia

Kaynakça

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