Trombositozlu Olgularda Terapötik Trombosit Aferezinin Etkinliği

Year 2021, Volume: 74 Issue: 3, 278 - 282, 17.09.2021

Zehra Narlı Özdemir

Abstract

Amaç: Trombosit azaltılması olarak da bilinen terapötik trombosit aferezi (TTA), semptomatik hastalarda veya aşırı trombositozlu yüksek riskli
hastaların profilaksisinde hızlı sitoredüksiyon için kullanılabilir. Bu yazıda, merkezimizin yaklaşık 20 yıllık TTA deneyimini sunuyoruz.
Gereç ve Yöntem: Ocak 1999 - Aralık 2020 tarihleri arasında yapılan TTA işlemleri için Ankara Üniversitesi Tıp Fakültesi Terapötik Aferez Ünitesi
tıbbi kayıtları retrospektif olarak incelendi.

Bulgular: Kırk altı (%51,1) erkek, 44 (%48,9) kadın olmak üzere 90 hastaya toplam 196 TTA işlemi yapıldı. Ortanca yaş 52,5 yıl (18-83 yıl) olarak
saptandı. Yetmiş dört (%82,2) hasta esansiyel trombositoz (ET), 5 (%5,6) hasta kronik miyeloid lösemi (KML), 5 (%5,6) hasta primer miyelofibrozis
(PMF), 3 (%3,3) hasta akut fazda yaygın tromboz ve 3 (%3,3) hasta diğer tanılarla işleme alındı. Altmış bir (%67,8) hastanın başlangıç trombosit
sayısı <1.500x109/L, 29 (%32,2) hastanın ≥1.500x109/L ve ortanca başlangıç trombosit sayısı 1.230x109/L (545-3.825x109/L) olarak bulundu. Otuz
üç (%36,7) hasta >1 TTA işlemine ihtiyaç duydu. TTA ile trombosit sayısı ortanca 571,5x109/L (72-3.128x109/L) ve %47,5 (%6,2-%92,4) azaltıldı.
TTA prosedürleri sonucunda 19 (%21,1) hastada ≤450x109/L, 56 (%62,2) hastada 450-1.000x109/L, 15 (%16,7) hastada ≥1.000x109/L PLT sayısı elde
edildi. Hastalar başlangıç trombosit sayılarına göre PLT <1.500x109/L ve PLT≥1.500x109/L olarak iki gruba ayrıldı. Trombosit sayısındaki azalma PLT
≥1.500x109/L olan grupta anlamlı olarak daha yüksek bulunurken [sırasıyla; 477x109/L (72-1.644) ve 1.142x109/L (363-3.128), p=0,001], trombosit
sayısının azalma oranı benzer bulundu [sırasıyla; %46,1 (6,2-92,4) ve %50,9 (18,3-89,2), p=0,097].

Sonuç: TTA trombosit sayısının hızlı bir şekilde azaltılmasını sağlamaktadır ve akut ciddi trombo-hemorajik komplikasyonlu hastalar veya çok yüksek
trombosit sayısı olan yüksek riskli hastalar için uygundur.

Keywords

Trapötik Trombosit Aferezi, Trombositoz, Sitoredüksiyon

The Efficacy of Therapeutic Thrombocytapheresis in Patients with Thrombocytosis

Abstract

Objectives: Therapeutic thrombocytapheresis (TTA), also known as platelet depletion, is used for rapid cytoreduction in symptomatic patients or
prophylaxis of high-risk patients with extreme thrombocytosis. In this paper, we present our center’s nearly 20-year experience with TTA.
Materials and Methods: The medical registry of Ankara University Faculty of Medicine Therapeutic Apheresis Unit was retrospectively reviewed for
TTA procedures between January 1999 and December 2020.

Results: One hundred and ninety-six TTA procedures were applied to 90 patients, including 46 (51.1%) males and 44 (48.9%) females. The median
age was 52.5 years (18-83). Seventy-four (82.2%) patients with essential thrombocytosis, 5 (5.6%) with chronic myeloid leukemia, 5 (5.6%) with
primary myelofibrosis, 3 (3.3%) with thrombosis in acute phase and 3 (3.3%) with others were treated. 61 (67.8%) patients had initial platelet
count as <1,500x109/L, 29 (32.2%) patients ≥1,500x109/L. The median initial platelet count was 1,230x109/L (545-3,825x109/L). Thirty-three (36.7%)
patients required >1 TTA procedures. The decrease of platelet count was 571.5x109/L (72-3,128x109/L) and 47.5% (6.2-92.4). After TTA, the PLT count
was ≤450x109/L in 19 (21.1%) patients, 450-1,000x109/L in 56 (62.2%) patients, and≥1,000 x109/L in 15 (16.7%) patients. The patients were divided
into two groups according to initial platelet count. The decrease in platelet count was significantly higher in the group with PLT ≥1,500x109/L[477x109/L (72-1,644) vs 1,142x109/L (363-3,128), respectively, p=0.001]. The rate of reduction was similar [46.1% (6.2-92.4) vs 50.9% (18.3-89.2),
respectively, p=0.097].

Conclusion: TTA can provide rapid reduction of platelet count and is suitable for patients with acute serious thrombotic or hemorrhagic events or
high-risk patients with very high platelet counts.

Keywords

Therapeutic Thrombocytapheresis, Thrombocytosis, Cytoreduction

Ethical Statement

Etik Etik Kurul Onayı: Ankara Üniversitesi İnsan Araştırmaları Etik Kurulu tarafından onaylanmıştır (karar no: İ1-58-21). Hasta Onayı: Ankara Üniversitesi Tıp Fakültesi Terapötik Aferez Ünitesi’nin medikal kayıtları geriye dönük incelendi. Hakem Değerlendirmesi: Editörler kurulunun dışındaki kişiler tarafından değerlendirilmiştir.

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