Kronik Böbrek Yetmezliği Tanılı Çocuk Hastada, COVİD-19 İzolasyonu Sırasında Eritropoetin’in Aşırı Kullanımından Dolayı Ortaya Çıkan Polisitemi Olgusu

Abstract

COVID-19 izolasyonu sırasında eritrosit stimule ajanın (ESA) aşırı kullanımına bağlı gelişen polisitemi vakası sunmayı amaçladık. On iki yaşında ki kronik böbrek yetmezliği tanılı erkek hastamız , COVID-19 pandemisinden dolayı 4 ay boyunca tecritte kaldığı için rutin kontrollerine gelememişti. Bu süre zarfında haftada 150 U / kg başlangıç dozunda ESA almaya devam etti. Hasta periton diyaliz tedavisi altında idi. Laboratuvar incelemelerinde hemoglobin (Hb) seviyesi 20.8 g / dl, hematokrit % 66, kreatinin 6.5 mgr / dl bulundu. Hastaya günlük flebotomi seansları (10cc / kg / seans) uygulandı. Bu dönemde aspirin tedavisi de başlandı (5 mg / kg). Beş seans sonunda Hb seviyesi 14 gr / dl'ye, hematokriti% 40'a düştü. Kronik Böbrek yetmezliği hastalarında hemoglobin düzeyi rutin şekilde takip edilmediği takdirde ESA’ ya bağlı polisitemi gelişebileceği başta aile hekimi olmak üzere tüm hekimler tarafından bilinmeli ve izolasyonda olsa dahi hastalar gerekirse ev ziyarteleri ile takip edilmeli.

Keywords

• Kronik Böbrek Yetmezliği
• Eritrosit uyarıcı ajan
• Polisitemi

Polycythemia in a Pediatric Patient with Chronic Kidney Disease: Overuse of Erythropoerin Due COVID-19 Isolation

Abstract

We describe a case of a patient with Chronic Kidney Disease who developed polycythemia due to Erythrocyte stimulating agents overuse during COVID-19 isolation. A 12-year-old male had not been able to attend routine controls since had been in isolation for 4 months after the COVID-19 outbreak. He had continued to take ESA during that period at the starting dose of 150 U/kg/week. He had been on peritoneal dialysis in the last year because of end-stage renal failure. Laboratory investigation revealed a hemoglobin (Hb) level of 20.8 g/dl, hematocrit level of 66%, creatinine level of 6.5 mgr/dl. He underwent daily phlebotomy sessions (10cc/kg/session). During this period aspirin was also started (5mg/kg). After 5 sessions his Hb level decreased to 14 gr/dl and hematocrit to 40%. Pediatric nephrologist should being aware that there is a potential risk of polycythemia with ESA when Hb level is not appropriately followed on a routine basis.

Keywords

• Chronic Kidney Disease
• Erythrocyte stimulating agent
• Polycythemia

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