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İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ

Year 2020, Volume: 83 Issue: 2, 138 - 145, 23.03.2020

Abstract

Amaç: İdiyopatik trombositopenik purpura (İTP) otoantikorlar ile kaplanmış trombositlerin yıkımı sonucunda trombositopeni oluşumuna sebep olur. Retikülotrombositler (RT) rezidüel, mesajcı ribonükleik asit (mRNA) ve ribosomal ribonükleik asit (rRNA) içeren genç trombositlerdir. Retikülotrombositlerin ölçümü İTP’li ve diğer trombositopenik hastalarda trombopoetik aktivite ile ilişkili bilgi verir. Bu çalışmada, yeni tanı konan ve refrakter İTP’li hastalarda RT yüzdesinin ve mutlak sayısının belirlenmesi ve tedavi cevabı ile ilişkisinin araştırılması amaçlandı. Gereç ve Yöntem: Çalışma, çeşitli tedavilere refrakter 16 hasta, yeni tanı konan 15 hasta ve 20 sağlıklı kontrol ile yapıldı. Trombosit sayısı ve ortalama trombosit hacmi belirlendi. RT’ler akım sitometrik yöntem ile ölçüldü. Bulgular: Olguların 35’i (%68,6) kadın, 16’sı (%31,4) erkekti. Olguların yaşları 20-75 arasında değişmekte olup ortalama 39,15± 13,04’tü. Refrakter hastalar “Grup 1” (n=16), yeni tanılı hastalar “Grup 2” (n=15) ve kontrol grubu olguları “Grup 3” (n=20) olarak adlandırıldı. Retikülotrombositler yüzdesi Grup 1’de %21,7, Grup 2’de %36,2 ve Grup 3’te %3,2 bulundu. Grup 3 ile Grup 1 ve 2 arasında anlamlı fark bulundu (p:0,001). Mutlak RT sayıları açısından anlamlı fark bulunmadı. Sonuç: Retikülotrombosit yüzdesi ölçümü ile, refrakter ve yeni tanılı İTP hastaları arasında fark saptanmamıştır. Retikülotrombosit yüzdesi ölçümünün tedaviye yanıtı göstermediği sonucuna varılmıştır. Refrakter hastalarda RT yüzdesinin yüksek bulunması tedaviye devam edilmesi gerektiğini gösterebilir.

Supporting Institution

Bu çalışma İstanbul Tıp Fakültesi Bilimsel Araştırma ve Proje Birimi tarafından desteklenmiştir.

References

  • 1. Stevens W, Koene H, Zwazinga JJ, Vreugdenhil G. Chronic idiopathic thrombocytopenic purpura:present strategy, guidelines and new insights. Neth J Med 2006;64(10):356-63.
  • 2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002;346(13):995-1008.
  • 3. McMillan R,Wang L, Tomer A, Nichol J, Pistollo J. Supression of in vitro megakaryocyte production by antiplatelet autoantibodies from adult patients with chronic ITP. Blood 2004;103(4):1364-9.
  • 4. British Committee for Standarts in Haematology General Haematology Task Force. Guidelines in the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003;120(4):574-96.
  • 5. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115(2):16886.
  • 6. Jubelirer SJ, Harpold R. The role of the bone marrow examination in the diagnosis of immune thrombocytopenic purpura: case series and literature review. Clin Appl Thromb Hemost 2002;8(1):73-6.
  • 7. Monteagudo M, Amengual MJ, Munoz L, Soler JN, Roıg I, Tolosa C. Reticulated platelets as a screening test to identify thrombocytopenia aetiology. QJM 2008;101(7):54955.
  • 8. Kienast J, Schmitz G. Flow cytometric analysis of thiazole orange uptake by platelets: a diagnostic aid in the evaluation of thrombocytopenic disorders. Blood 1990;75(1):116-21.
  • 9. Chavda N, Mackie IJ, Porter JB, Harrison P, Patterson K, Machin SJ. Rapid flow cytometric quantitation of reticulated platelets in whole blood. Platelets. 1996;7(4):189-94.
  • 10. Harrison P, Robinson MSC, Mackie IJ, Machin SJ. Reticulated platelets. Platelets 1997;8(6):379-83.
  • 11. Salvagno GL, Montagnana M, Degan M, Marradi PL, Ricetti MM, Riolfi P, Poli G, Minuz P, Santonastaso CL, Guidi GC. Evaluation of platelet turnover by flow cytometry. Platelets 2006;17(3):170-7.
  • 12. Ingram M, Coopersmith A. Reticulated platelets following acute blood loss. Br J Haematol 1969;17(3):225-9.
  • 13. Van Karaij MGJ, Kok KF, Penings A, Verbruggen HW, Novakova IRO. Higher reticulated platelet counts and enhanced expression of P-selectin in patients with immune thrombocytopenic purpura compared to patients with myelodysplastic syndromes. Journal of Thrombosis and Haemostasis 2003;1(suppl 1):12-8.
  • 14. Saxon BR, Blanchette VS, Butchart S, Lim-Yin J, Poon AO. Reticulated platelet counts in the diagnosis of acute immune thrombocytopenic purpura. J Ped Hematol Oncol 1998;20(1):44-8.
  • 15. Thomas-Kaskel AK, Mattern D, Köhler G, Finke J, Behringer D. Reticulated platelet counts corralate with treatment response in patients with idiopathic thrombocytopenic purpura and help identify the complex causes of thrombocytopenia in patients after allogenic hematopoetic stem cell transplantation Cytometry B Clin Cytom 2007;72(4):241-8.
  • 16. Portielle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbiditiy and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97(9):2549-54.
  • 17. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 2000;160(11):1630-8.
  • 18. Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Ann Intern Med 1997;126(4):319-26.
  • 19. Blanchette V, Freedman J, Garvy B. Management of chronic immune thrombocytopenic purpura in children and adults. Semin Hematol 1998;35(1 suppl 1):36-51.
  • 20. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a guideline developed by explicit methods for the American Society of Haematology Blood. 1996;88(1):3-40.
  • 21. Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. Mayo Clinic Prc 2004;79(4):504-22.
  • 22. Thienett CD, Calverley DC. Thrombocytopenia Caused by Immunologic Platelet Destruction. Wintrobe’s Clinical Hematology. 12th ed. Lippincott Williams&Wilkins;2009:1749-83.
  • 23. Hacıhanefioğlu A. Trombositopenili hastalarda trombopoezi değerlendirmede flow-sitometrik yöntemle TO+ (retikülotrombosit) sayımlarının yeri. İstanbul Üniversitesi İstanbul Tıp Fakültesi Hematoloji Bilim Dalı. 1999.
  • 24. Abe Y,Wada H, Sakakura M, Nishioka J, Tomatsu H, Hamaguchi Y, Oguni S, Shiku H, Nobori T. Usefullness of Fully Automated Measurement of Reticulated Platelets Using Whole Blood. Clin Appl Thromb Hemost 2005;11(3):263-70.
  • 25. Briggs C, Kunka S, Hart D, Oguni S, Machin SJ. Assessment of an immature platelet fraction(IPF) in peripheral thrombocytopenia. Br J Haematol 2004;126(1):93-9.

THE ASSOCIATION OF RETICULATED THROMBOCYTE COUNT WITH TREATMENT RESPONSE IN PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

Year 2020, Volume: 83 Issue: 2, 138 - 145, 23.03.2020

Abstract

Objective: Idiopathic thrombocytopenic purpura (ITP) causes thrombocytopenia via the premature destruction of autoantibody covered thrombocytes. It is diagnosed by exclusion of other diseases which cause thrombocytopenia. Reticulothrombocytes (RT) are young thrombocytes containing messenger ribonucleic acid (mRNA) and ribosomal ribonucleic acid (rRNA). Measurement of RT with flow cytometry is reported to reflect thrombopoetic activity in thrombocytopenic patients. The aim of this study is to measure the percentage and absolute number of RT’s in newly diagnosed and refractory ITP patients and to investigate the association between RT percentage and number with response to treatment. Material and Method: The study group consisted of 16 former ITP patients who were refractory to various treatments, 15 newly diagnosed patients and 20 healthy controls. Thrombocyte counts and mean thrombocyte volume were measured with blood count. RT counts were measured via flow cytometry. Reticulocyte counts of the refractory patients, new patients and healthy controls were compared to each other. Results: Thirty five (68.6%) of the 51 patients were female. The patients were between 25 and 75 years old with a mean age of 39.15 years and standard deviation of 13.04 years. The refractory ITP patients and newly diagnosed ITP patients were grouped into Group 1 (n=16) and Group 2 (n=15) respectively. The control group was referred to as Group 3 (n=20). The platelet count of Group 3 was found to be significantly higher than the platelet counts of Groups 1 and 2 (p:0.001) and there was no difference between Groups 1 and 2. The RT percentage was found 21.7% in Group 1, 36.2% in Group 2 and 3.2% in Group 3. The RT percentage of Group 3 was calculated to be significantly lower than the RT percentages of Groups 1 and 2 (p:0.001). There was no difference between Groups 1 and 2. The absolute RT count was insignificant between all groups. Conclusion: The RT percentage count was not statistically different between refractory and newly diagnosed ITP patients. This finding indicates that RT percentage measurement is not helpful in the evaluation of the response to the treatment. The finding of a high RT percentage count in refractory patients suggests that the medical treatment should be continued. 

References

  • 1. Stevens W, Koene H, Zwazinga JJ, Vreugdenhil G. Chronic idiopathic thrombocytopenic purpura:present strategy, guidelines and new insights. Neth J Med 2006;64(10):356-63.
  • 2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002;346(13):995-1008.
  • 3. McMillan R,Wang L, Tomer A, Nichol J, Pistollo J. Supression of in vitro megakaryocyte production by antiplatelet autoantibodies from adult patients with chronic ITP. Blood 2004;103(4):1364-9.
  • 4. British Committee for Standarts in Haematology General Haematology Task Force. Guidelines in the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003;120(4):574-96.
  • 5. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115(2):16886.
  • 6. Jubelirer SJ, Harpold R. The role of the bone marrow examination in the diagnosis of immune thrombocytopenic purpura: case series and literature review. Clin Appl Thromb Hemost 2002;8(1):73-6.
  • 7. Monteagudo M, Amengual MJ, Munoz L, Soler JN, Roıg I, Tolosa C. Reticulated platelets as a screening test to identify thrombocytopenia aetiology. QJM 2008;101(7):54955.
  • 8. Kienast J, Schmitz G. Flow cytometric analysis of thiazole orange uptake by platelets: a diagnostic aid in the evaluation of thrombocytopenic disorders. Blood 1990;75(1):116-21.
  • 9. Chavda N, Mackie IJ, Porter JB, Harrison P, Patterson K, Machin SJ. Rapid flow cytometric quantitation of reticulated platelets in whole blood. Platelets. 1996;7(4):189-94.
  • 10. Harrison P, Robinson MSC, Mackie IJ, Machin SJ. Reticulated platelets. Platelets 1997;8(6):379-83.
  • 11. Salvagno GL, Montagnana M, Degan M, Marradi PL, Ricetti MM, Riolfi P, Poli G, Minuz P, Santonastaso CL, Guidi GC. Evaluation of platelet turnover by flow cytometry. Platelets 2006;17(3):170-7.
  • 12. Ingram M, Coopersmith A. Reticulated platelets following acute blood loss. Br J Haematol 1969;17(3):225-9.
  • 13. Van Karaij MGJ, Kok KF, Penings A, Verbruggen HW, Novakova IRO. Higher reticulated platelet counts and enhanced expression of P-selectin in patients with immune thrombocytopenic purpura compared to patients with myelodysplastic syndromes. Journal of Thrombosis and Haemostasis 2003;1(suppl 1):12-8.
  • 14. Saxon BR, Blanchette VS, Butchart S, Lim-Yin J, Poon AO. Reticulated platelet counts in the diagnosis of acute immune thrombocytopenic purpura. J Ped Hematol Oncol 1998;20(1):44-8.
  • 15. Thomas-Kaskel AK, Mattern D, Köhler G, Finke J, Behringer D. Reticulated platelet counts corralate with treatment response in patients with idiopathic thrombocytopenic purpura and help identify the complex causes of thrombocytopenia in patients after allogenic hematopoetic stem cell transplantation Cytometry B Clin Cytom 2007;72(4):241-8.
  • 16. Portielle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbiditiy and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97(9):2549-54.
  • 17. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 2000;160(11):1630-8.
  • 18. Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Ann Intern Med 1997;126(4):319-26.
  • 19. Blanchette V, Freedman J, Garvy B. Management of chronic immune thrombocytopenic purpura in children and adults. Semin Hematol 1998;35(1 suppl 1):36-51.
  • 20. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a guideline developed by explicit methods for the American Society of Haematology Blood. 1996;88(1):3-40.
  • 21. Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. Mayo Clinic Prc 2004;79(4):504-22.
  • 22. Thienett CD, Calverley DC. Thrombocytopenia Caused by Immunologic Platelet Destruction. Wintrobe’s Clinical Hematology. 12th ed. Lippincott Williams&Wilkins;2009:1749-83.
  • 23. Hacıhanefioğlu A. Trombositopenili hastalarda trombopoezi değerlendirmede flow-sitometrik yöntemle TO+ (retikülotrombosit) sayımlarının yeri. İstanbul Üniversitesi İstanbul Tıp Fakültesi Hematoloji Bilim Dalı. 1999.
  • 24. Abe Y,Wada H, Sakakura M, Nishioka J, Tomatsu H, Hamaguchi Y, Oguni S, Shiku H, Nobori T. Usefullness of Fully Automated Measurement of Reticulated Platelets Using Whole Blood. Clin Appl Thromb Hemost 2005;11(3):263-70.
  • 25. Briggs C, Kunka S, Hart D, Oguni S, Machin SJ. Assessment of an immature platelet fraction(IPF) in peripheral thrombocytopenia. Br J Haematol 2004;126(1):93-9.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section RESEARCH
Authors

Ayşe Serra Artan 0000-0002-6461-3178

Meliha Nalçacı This is me 0000-0002-2555-5024

Publication Date March 23, 2020
Submission Date December 26, 2018
Published in Issue Year 2020 Volume: 83 Issue: 2

Cite

APA Artan, A. S., & Nalçacı, M. (2020). İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ. Journal of Istanbul Faculty of Medicine, 83(2), 138-145.
AMA Artan AS, Nalçacı M. İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ. İst Tıp Fak Derg. March 2020;83(2):138-145.
Chicago Artan, Ayşe Serra, and Meliha Nalçacı. “İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ”. Journal of Istanbul Faculty of Medicine 83, no. 2 (March 2020): 138-45.
EndNote Artan AS, Nalçacı M (March 1, 2020) İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ. Journal of Istanbul Faculty of Medicine 83 2 138–145.
IEEE A. S. Artan and M. Nalçacı, “İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ”, İst Tıp Fak Derg, vol. 83, no. 2, pp. 138–145, 2020.
ISNAD Artan, Ayşe Serra - Nalçacı, Meliha. “İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ”. Journal of Istanbul Faculty of Medicine 83/2 (March 2020), 138-145.
JAMA Artan AS, Nalçacı M. İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ. İst Tıp Fak Derg. 2020;83:138–145.
MLA Artan, Ayşe Serra and Meliha Nalçacı. “İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ”. Journal of Istanbul Faculty of Medicine, vol. 83, no. 2, 2020, pp. 138-45.
Vancouver Artan AS, Nalçacı M. İDİYOPATİK TROMBOSİTOPENİK PURPURALI HASTALARDA RETİKÜLOTROMBOSİT SAYISININ TEDAVİ CEVABI İLE İLİŞKİSİ. İst Tıp Fak Derg. 2020;83(2):138-45.

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