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Farklı Trombositopeni Sebeplerinin Klinik ve Laboratuvar Bulguları

Year 2017, Volume: 7 Issue: 4, 316 - 322, 04.12.2017
https://doi.org/10.16899/gopctd.360762

Abstract

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.

References

  • 1. Williamson DR, Albert M, Heels-Ansdell D, Arnold DM, Lauzier F, Zarychanski R, Crowther M, Warkentin TE, Dodek P, Cade J et al: Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest 2013, 144(4):1207-1215.
  • 2. Kappler S, Ronan-Bentle S, Graham A: Thrombotic microangiopathies (TTP, HUS, HELLP). Emergency medicine clinics of North America 2014, 32(3):649-671.
  • 3. Stasi R: How to approach thrombocytopenia. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program 2012, 2012:191-197.
  • 4. Veneri D, Franchini M, Randon F, Nichele I, Pizzolo G, Ambrosetti A: Thrombocytopenias: a clinical point of view. Blood transfusion = Trasfusione del sangue 2009, 7(2):75-85.
  • 5. Townsley DM, Desmond R, Dunbar CE, Young NS: Pathophysiology and management of thrombocytopenia in bone marrow failure: possible clinical applications of TPO receptor agonists in aplastic anemia and myelodysplastic syndromes. International journal of hematology 2013, 98(1):48-55.
  • 6. Abadi U, Yarchovsky-Dolberg O, Ellis MH: Immune thrombocytopenia: recent progress in pathophysiology and treatment. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2015, 21(5):397-404.
  • 7. Galbusera M, Noris M, Remuzzi G: Thrombotic thrombocytopenic purpura--then and now. Seminars in thrombosis and hemostasis 2006, 32(2):81-89.
  • 8. Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ, British Committee for Standards in H: Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. British journal of haematology 2012, 158(3):323-335.
  • 9. Zheng XL, Kaufman RM, Goodnough LT, Sadler JE: Effect of plasma exchange on plasma ADAMTS13 metalloprotease activity, inhibitor level, and clinical outcome in patients with idiopathic and nonidiopathic thrombotic thrombocytopenic purpura. Blood 2004, 103(11):4043-4049.
  • 10. McCrae KR, Bussel JB, Mannucci PM, Remuzzi G, Cines DB: Platelets: an update on diagnosis and management of thrombocytopenic disorders. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program 2001:282-305.
  • 11. Gauer RL, Braun MM: Thrombocytopenia. American family physician 2012, 85(6):612-622.
  • 12. Kim KY, Kim KE, Kim KH: Mean platelet volume in the normal state and in various clinical disorders. Yonsei medical journal 1986, 27(3):219-226.
  • 13. Eldor A, Avitzour M, Or R, Hanna R, Penchas S: Prediction of haemorrhagic diathesis in thrombocytopenia by mean platelet volume. British medical journal 1982, 285(6339):397-400.
  • 14. Dahlan R, Sontrop JM, Li L, Ghadieh O, Clark WF: Primary and Secondary Thrombotic Microangiopathy Referred to a Single Plasma Exchange Center for Suspected Thrombotic Thrombocytopenic Purpura: 2000-2011. American journal of nephrology 2015, 41(6):429-437.
  • 15. Gurkan E, Baslamisli F, Guvenc B, Kilic NB, Unsal C, Karakoc E: Thrombotic thrombocytopenic purpura in southern Turkey: a single-center experience of 29 cases. Clinical and laboratory haematology 2005, 27(2):121-125.
  • 16. Mariotte E, Veyradier A: Thrombotic thrombocytopenic purpura: from diagnosis to therapy. Current opinion in critical care 2015, 21(6):593-601.
  • 17. Coppo P, Froissart A, French Reference Center for Thrombotic M: Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program 2015, 2015(1):637-643.

Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia

Year 2017, Volume: 7 Issue: 4, 316 - 322, 04.12.2017
https://doi.org/10.16899/gopctd.360762

Abstract

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.   


References

  • 1. Williamson DR, Albert M, Heels-Ansdell D, Arnold DM, Lauzier F, Zarychanski R, Crowther M, Warkentin TE, Dodek P, Cade J et al: Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest 2013, 144(4):1207-1215.
  • 2. Kappler S, Ronan-Bentle S, Graham A: Thrombotic microangiopathies (TTP, HUS, HELLP). Emergency medicine clinics of North America 2014, 32(3):649-671.
  • 3. Stasi R: How to approach thrombocytopenia. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program 2012, 2012:191-197.
  • 4. Veneri D, Franchini M, Randon F, Nichele I, Pizzolo G, Ambrosetti A: Thrombocytopenias: a clinical point of view. Blood transfusion = Trasfusione del sangue 2009, 7(2):75-85.
  • 5. Townsley DM, Desmond R, Dunbar CE, Young NS: Pathophysiology and management of thrombocytopenia in bone marrow failure: possible clinical applications of TPO receptor agonists in aplastic anemia and myelodysplastic syndromes. International journal of hematology 2013, 98(1):48-55.
  • 6. Abadi U, Yarchovsky-Dolberg O, Ellis MH: Immune thrombocytopenia: recent progress in pathophysiology and treatment. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2015, 21(5):397-404.
  • 7. Galbusera M, Noris M, Remuzzi G: Thrombotic thrombocytopenic purpura--then and now. Seminars in thrombosis and hemostasis 2006, 32(2):81-89.
  • 8. Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, Cheung B, Machin SJ, British Committee for Standards in H: Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. British journal of haematology 2012, 158(3):323-335.
  • 9. Zheng XL, Kaufman RM, Goodnough LT, Sadler JE: Effect of plasma exchange on plasma ADAMTS13 metalloprotease activity, inhibitor level, and clinical outcome in patients with idiopathic and nonidiopathic thrombotic thrombocytopenic purpura. Blood 2004, 103(11):4043-4049.
  • 10. McCrae KR, Bussel JB, Mannucci PM, Remuzzi G, Cines DB: Platelets: an update on diagnosis and management of thrombocytopenic disorders. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program 2001:282-305.
  • 11. Gauer RL, Braun MM: Thrombocytopenia. American family physician 2012, 85(6):612-622.
  • 12. Kim KY, Kim KE, Kim KH: Mean platelet volume in the normal state and in various clinical disorders. Yonsei medical journal 1986, 27(3):219-226.
  • 13. Eldor A, Avitzour M, Or R, Hanna R, Penchas S: Prediction of haemorrhagic diathesis in thrombocytopenia by mean platelet volume. British medical journal 1982, 285(6339):397-400.
  • 14. Dahlan R, Sontrop JM, Li L, Ghadieh O, Clark WF: Primary and Secondary Thrombotic Microangiopathy Referred to a Single Plasma Exchange Center for Suspected Thrombotic Thrombocytopenic Purpura: 2000-2011. American journal of nephrology 2015, 41(6):429-437.
  • 15. Gurkan E, Baslamisli F, Guvenc B, Kilic NB, Unsal C, Karakoc E: Thrombotic thrombocytopenic purpura in southern Turkey: a single-center experience of 29 cases. Clinical and laboratory haematology 2005, 27(2):121-125.
  • 16. Mariotte E, Veyradier A: Thrombotic thrombocytopenic purpura: from diagnosis to therapy. Current opinion in critical care 2015, 21(6):593-601.
  • 17. Coppo P, Froissart A, French Reference Center for Thrombotic M: Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program 2015, 2015(1):637-643.
There are 17 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Serkan Akın

Şafak Akın

Tülay Karaağaç Akyol This is me

İbrahim Haznedaroğlu This is me

Publication Date December 4, 2017
Acceptance Date September 29, 2017
Published in Issue Year 2017 Volume: 7 Issue: 4

Cite

APA Akın, S., Akın, Ş., Karaağaç Akyol, T., Haznedaroğlu, İ. (2017). Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia. Çağdaş Tıp Dergisi, 7(4), 316-322. https://doi.org/10.16899/gopctd.360762
AMA Akın S, Akın Ş, Karaağaç Akyol T, Haznedaroğlu İ. Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia. J Contemp Med. December 2017;7(4):316-322. doi:10.16899/gopctd.360762
Chicago Akın, Serkan, Şafak Akın, Tülay Karaağaç Akyol, and İbrahim Haznedaroğlu. “Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia”. Çağdaş Tıp Dergisi 7, no. 4 (December 2017): 316-22. https://doi.org/10.16899/gopctd.360762.
EndNote Akın S, Akın Ş, Karaağaç Akyol T, Haznedaroğlu İ (December 1, 2017) Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia. Çağdaş Tıp Dergisi 7 4 316–322.
IEEE S. Akın, Ş. Akın, T. Karaağaç Akyol, and İ. Haznedaroğlu, “Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia”, J Contemp Med, vol. 7, no. 4, pp. 316–322, 2017, doi: 10.16899/gopctd.360762.
ISNAD Akın, Serkan et al. “Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia”. Çağdaş Tıp Dergisi 7/4 (December 2017), 316-322. https://doi.org/10.16899/gopctd.360762.
JAMA Akın S, Akın Ş, Karaağaç Akyol T, Haznedaroğlu İ. Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia. J Contemp Med. 2017;7:316–322.
MLA Akın, Serkan et al. “Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia”. Çağdaş Tıp Dergisi, vol. 7, no. 4, 2017, pp. 316-22, doi:10.16899/gopctd.360762.
Vancouver Akın S, Akın Ş, Karaağaç Akyol T, Haznedaroğlu İ. Clinical and Laboratory Findings in Various Reasons of Thrombocytopenia. J Contemp Med. 2017;7(4):316-22.