Kronik İmmun Trombositopenik Purpurada splenektomi Öncesi Tc-99m Sülfür Kolloid Sintigrafisi Gerekli mi?

Year 2011, Volume: 3 Issue: 2, 19 - 22, 01.08.2011

Ilçe Ht

Abstract

Eriºkinlerde elektif splenektominin en sýk nedenlerinden biri Kronik Ýmmun Trombositopenik Purpuradýr. Hastalýk trombositlerin dalak tarafýndan yýkýlmasý ile karakterizedir. Bu nedenle splenektomi tedavide altýn standarttýr. Ancak ameliyat sonrasý geride dalak dokusunun kalmasý trombositopeninin devam etmesine neden olur. Geride dalak dokusunun kalmasýnýn baºlýca nedeni aksesuar dalaktýr. Bu nedenle ameliyat öncesi ve sonrasý bu dokunun saptanmasý önemlidir. 30 yaºýnda erkek hasta. Dört yýl önce Kronik Ýmmun Trombositopenik Purpura nedeni ile laparoskopik splenektomi yapýlmýº. Hastanýn trombositopenisinin tekrarlamasý üzerine karýn utrasonografisi yapýlmýº ve normal olarak deðerlendirilmiº. Hastanýn yapýlan Tc-99m Sülfür Kolloid Dalak Sintigrafisinde sol hipokondriak bölgede dalak dokusu saptandý. Tc-99m Sülfür Kolloid Dalak Sintigrafisi ameliyat öncesi ve sonrasý aksesuar dalaðýn gösterilmesi için yapýlabilir bir görüntüleme yöntemidir. Özellikle ameliyat öncesi yapýlarak ameliyatta daha dikkatli olunmasý saðlanýr. Böylece saptanan aksesuar dalak çýkarýlarak hastalýðýn tekrar etmesi engellenmiº olur

Keywords

Ýmmun Trombositopenik Purpura, Aksesuar Dalak, SPECT

References

• Phom H, Dasan B, Kashyap R, et al. Detection of multiple accessory spleens in a patient with chronic idiopathic thrombocytopenia purpura. Clinical Nuc Med 2001; 26(7): 593-595.
• Castallani M, Cappellini DM, Fedriga CE, et al. Tc-99m Sulphur colloid scintigraphy in the assessment of residual splenic tissue after splenectomy. Clinical Rad 2001; 56(7): 596-598.
• Ballem PJ, Segal GM, Stratton JR, et al. Mechanisms of thrombocytopenia in chronic autoimmune thrombocytopenic purpura; evidence of both impaired platelet production and increased platelet clearance. J Clin Invest 1987; 80(1): 33-40.
• Stasi R, Stipa E, Masi M, et al. Long-term observations of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995; 98(5): 436-442.
• Portielje JE, Westendrop RG, Kluin-Nelemans HC et al. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001; 97(9): 2549-2554.
• Provan D, Newland A. Fifty years of idiopathic thrombocytopenic purpura (ITP): Management of ITP in adult. Br J Haematol 2002; 118(4):933-944.
• Bussel JB, Pham LC. Intravenous treatment with gammaglobulin in adults with immune thrombocytopenic purpura: review of the literature. Vox Sang 1987; 52(3): 206-211.
• George JN, el-Harake MA, Raskob GE. Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1994; 331(18): 1207-1211.
• Rudowski WJ. Accessory spleens: clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura. World J Surg 1985; 9(3): 422- 430.
• McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Intern Med 1997; 126(4):307-314.
• Ehrlich CP, Papanicolaou N, Treves S, et al. Splenic Scintigraphy using Tc-99m-labeled heat-denatured red blood cells in pediatric patients: concise communication. J Nucl Med 1982; 23(3):209-213.
• Massey MD, Stevens JS. Residual spleen found on denatured red blood cell scan following negative colloid scans. J Nucl Med 1991; 32(12):2286-2287.
• Phom H, Kumar A, Tripathi M, et al. Comparative evaluation of Tc-99m-heat-denatured RBC and Tc-99m- anti-D IgG opsonized RBC spleen planar and SPECT scintigraphy in the detection of accessory spleen in postsplenectomy patients with chronic idiopathic thrombocytopenic purpura. Clin Nucl Med 2004; 29(7):403-409.
• Hansen S, Jarhult J. Accessory spleen imaging. Radionuclide, ultrasound and CT investigations in a patient with trombocytopenia 25 yr after splenectomy for ITP. Scand J Haematol 1986;37(1):74-77.
• Koyanagi N, Kanematsu T, Sugimachi K. Preoperative computed tomography and scintigraphy to facilitate the detection of accessory spleen in patients with hematologic disorders. Jpn J Surg 1988; 18(1):101-104.
• Phom H, Dasan JB, Kashyap R, et al. Detection of multiple accsessory spleens in a patient with chronic idiopathic thrombocytopenia purpura. Clin Nucl Med 2001; 26(7):593-595.
• Antevil J, Thoman D, Taller J, et al. Laparoscopic accessory splenectomy with intraoperative gamma probe localization for recurrent idiopathic thrombocytopenic purpura. Surg Laparosc Endosc Percutan Tech 2002;12(5):371-374.
• Pohlson EC, Wilkinson RW, Witzum KF, et al. Heat-damaged red cell scans for intraoperative localization of the accessory spleen. J Pediatr Surg 1994; 29(5):604-608.
• Bergeron E, Ratte S, Jeannotte S, et al. The use of handheld gamma probe for identifying two accessory spleens in difficult locations in the same patient. Ann Nucl Med. 2008; 22(4):331ñ3.Epub 2008 Jun 6
• Coventry BJ, Watson DI, Tucker K, et al. Intraoperative scintigraphic localization and laparoscopic excision of accessory splenic tissue. Surg Endosc 1998;12(2):159-161.