Akut immün trombositopenik purpura tanısı alan hastaların retrospektif değerlendirilmesi ve yüksek doz metilprednizolon ile intravenöz immunglobulin tedavilerinin karşılaştırılması

Year 2019, Volume: 11 Issue: 3, 303 - 308, 01.09.2019

Mahmut Aslan , Ünsal Özgen Neslian Aslan

https://doi.org/10.21601/ortadogutipdergisi.482032

Abstract

Amaç: Çocukluk çağında en sık görülen edinsel trombositopeni nedenlerinden birisi immün trombositopenik purpuradır. İmmün trombositopenik purpura (İTP), otoantikorla kaplı trombositlerin retiküloendotelyal sistemde doku makrofajları aracılığıyla yıkılarak dolaşımdaki trombosit sayısının azalması ve bu otoantikorların trombosit üretimini inhibe etmesi ile seyreden otoimmün bir hastalıktır. Bu çalışmada akut immün trombositopenik purpura tanısı almış hastaların dosyaları retrospektif olarak incelendi. Hastaların başvuru sırasındaki klinik özellikleri ve tedavi seçiminin etkinlikleri belirlenmeye çalışıldı.
Gereç ve Yöntemler: Hastanemiz Çocuk Hematoloji Kliniğinde, Ocak 2010 - Ağustos 2014 tarihleri arasında akut immün trombositopenik purpura tanısı alan hastalar çalışmaya dâhil edildi. Hasta dosyaları retrospektif olarak incelendi. Yüksek doz metilprednizolon ve intravenöz immunglobulin (İVİG) tedavileri alan hastaların tedaviye yanıtları karşılaştırıldı.
Bulgular: Çalışmamıza alınan hastaların 91’i (%56,9) erkek idi. Hastaların %48,13’ünde başvurudan 1-4 hafta öncesinde geçirilmiş enfeksiyon öyküsü mevcuttu. Hastaların ortalama trombosit sayısı 12081±11912 /mm3 idi. Yüz beş (%65,6) hastaya yüksek doz metilprednizolon, 55 (%34,4) hastaya İVİG tedavileri verilmişti ve tedavinin 10. gününde, tedaviye yanıt açısından istatistiksel olarak yüksek doz metilprednizolon ile intravenöz immunglobulin arasında anlamlı fark saptanmadı (p=0,732). Altı ayın sonunda yüksek doz metilprednizolon verilen hastalar ile intravenöz immunglobulin verilen hastalar arasında kronikleşme açısından anlamlı ilişki saptanmadı (p=0,468). Başvuru anında bakılan kanama zamanı 7 dakikanın üzerinde olan %15 hastanın kronikleşme gelişme oranı daha yüksek saptandı (p=0,031).
Sonuç: İmmün trombositopenik purpura çocukluk çağında sık görülen bir hastalık olup hastaların %20-30’u kronikleşmektedir. Yüksek doz metilprednizolon ile intravenöz immunglobulin tedavilerinin kronikleşme üzerine etkisi açısından aralarında fark saptanmamıştır.

Keywords

Çocukluk, İmmün Trombositopenik Purpura, İntravenöz İmmunglobulin, Metilprednizolon

The retrospective evaluation of patients diagnosed with acute immune thrombocytopenic purpura and comparison of treatments of high-dose methylprednisolone and intravenous immunoglobulin

Abstract

Objective: One of the most common causes for acquired thrombocytopenia in childhood is immune thrombocytopenic purpura (ITP) which is an autoimmune disease characterized by decreased platelet counts and inhibition of platelet production due to antibody-mediated destruction of platelets by macrophages in the reticulo endothelial system. In this study, we aimed to compare high-dose methylprednisolone (HDMP) and intravenous immunoglobulin (IVIG) in the treatment ITP.
Materials and Methods: The medical records of 160 patients who were admitted to our Pediatric Hematology Department with the diagnosis of acute ITP between January 2010 and August 2014 were retrospectively analyzed. Treatment responses to HDMP and IVIG were compared.
Results: Of the patients, 91 (56.9%) were males. A total of 48.13% of them had a previous history of infection for one to four weeks before admission. The mean platelet count was 12.081±11.912 /mm3. A total of 105 patients received HDMP, while 55 patients received IVIG. There was no statistically significant difference in the treatment response to HDMP or IVIG on the 10th day of the treatment (p=0.732). At the end of six months, there was no significant difference between the patients receiving HDMP and IVDG in terms of progression to chronicity (p=0.468). The rate of chronicity and relapses was found to be statistically significantly higher in 15% of the patients with a bleeding time of more than 7 minute at the time of arrival (p=0.031).
Conclusion: Based on our study results, we suggest that HDMP and IVIG treatments have similar effects on disease progression to chronicity.

Keywords

Childhood, Immune Thrombocytopenic Purpura, Intravenous Immunoglobulin, Methylprednisolon

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