İmmun Trombositopenik Purpura Tanılı Çocuklarda İntravenöz İmmunoglobulin Tedavisini Etkileyen Prognostik Faktörler ve Tedavinin Kronikleşme Üzerine Etkisi

Yıl 2019, Cilt: 17 Sayı: 3, 350 - 358, 02.12.2019

Kadriye Nil Kaptan Emine Türkkan

Öz

GİRİŞ ve AMAÇ:
İmmun Trombositopeni (İTP) tanılı çocuklarda intravenöz immunoglobulin
tedavisini etkileyen prognostik faktörler ve tedavinin kronikleşme üzerine
etkisi belirlenmek istenmiştir.

YÖNTEM ve GEREÇLER: Çalışmaya;
2010-2016 yılları arasında başvuran, 3 ay- 16 yaş aralığındaki 80 hasta
alınmıştır. Her hastanın cinsiyeti, yaşı, tanı öncesin varsa enfeksiyon ve
aşılanma öyküsü, kanama bulguları, tanı anındaki laboratuvar değeri, IVIG
tedavisine yanıt süresi, tanıdan 1 yıl sonraki trombosit değeri incelenmiştir.
Akut ve kronik İTP tanısı alan gruplar arasında veriler karşılaştırılmıştır.

BULGULAR: İTP tanısı alan ve IVIG tedavisi verilen 80 olgunun
sosyodemografik ve laboratuvar özellikleri değerlendirildi. Yaş ortalaması
71,40±46,18 ay idi. Olgularımızda erkek/kız oranı 1,0 olarak tespit edildi. 32
olguda başvurudan önceki 6 hafta içerisinde, viral enfeksiyon geçirme öyküsü
vardı. Akut İTP’ lerin %11 inde trompositopeni gelişmeden önceki 6 hafta içinde
aşı olma öyküsü varken kronik İTP ‘lerde son 6 hafta içinde aşı öyküsü
saptanmadı. Akut İTP olgularının en çok sonbahar aylarında, kronik İTP
olgularının ön planda kış ve yaz aylarında tanı aldığı görüldü. Tüm hastaların
ortalama trombosit sayıları,WBC, MPV, PDW,
PCT, CRP, PT, aPTT değerleri değerlendirildiğinde
benzer sonuçlar elde edildi (p>0.05).

TARTIŞMA ve SONUÇ: İmmun Trombositopeni’de kronikleşmeyi ön görebilmek için demografik
özellikler, klinik bulgular, laboratuvar bulguları ve tedavi şekillerinden
ziyade otoantikorlar ve immun trompositopeninin genetik mekanizmalarına yönelik
ileri çalışmalara ihtiyaç olduğunu saptadık.

Anahtar Kelimeler

immun trombositopeni, çocuk, IVIG, prognostik faktörler

Prognostic Factors Affecting Intravenous Immunglobulin Therapy in Children Diagnosed Immune Thrombocytopenic Purpura and Effect of Treatment on Chronicity

Öz

INTRODUCTION:
Main purpose of this study is to evaluate the prognostic factors affecting
intravenous immunglobulin therapy in children diagnosed immune thrombocytopenic
purpura and effect of treatment on chronicity.

METHODS: 80
children who are 3 months-16 years old diagnosed with immune thrombocytopenia
during 2000-2016 were included in this study. The gender of each patient, age,
history of infection and vaccination before diagnosis, bleeding findings,
laboratory values at diagnosis, duration of response to IVIG treatment, and
thrombocyte counts after 1 year were examined. Data were compared between acute
and chronic ITP groups.

RESULTS:
Sociodemographic and laboratory characteristics of totally 80 children were
evaluated. The average age of children was 71.40±46.18 months. In our cases,
the ratio of male to female was 1,0. Thirty two of our cases (53.33%) had a
history of viral infection within 6 weeks prior to admission. 11% of acute ITPs
had a story of vaccination within 6 weeks prior to thrombocytopenia, whereas no
vaccination was detected within 6 weeks of chronic ITP. Acute ITP was diagnosed
in 22 cases in autumn at most, and chronic ITP was diagnosed in 7 cases in
winter and summer months. Similar results were obtained when tthe mean platelet
counts, WBC, MPV, PDW, PCT, CRP, PT, aPTT values of the patients were
evaluated.

DISCUSSION
AND CONCLUSION: We
need further studies on the genetic mechanism and autoantibodies in immune
thrombocytopenia with respect to demographics, clinical findings, laboratory
findings and treatment modalities to predict chronicity

Anahtar Kelimeler

immune thrombocytopenia, childhood, IVIG, prognostic factors

Kaynakça

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