İMMUN TROMBOSİTOPENİK PURPURADA İVİG SONRASI PULMONER TROMBOEMBOLİ GELİŞEN OLGUDA TROMBOLİTİK TEDAVİ KULLANIMI

Öz

İmmun trombositopenik purpura (İTP), glikoprotein IIb/IIIa'ya karşı gelişen antikorla kaplı trombositlerin retikülo-endotelyal sistemde yıkımı ile karakterize otoimmun bir hastalıktır. İntraven öz immunglobulin (İVİG); yaşamı tehlikeye sokan kanamalı kronik İTP'de, etkin ve güvenli bir tedavi yöntemi olarak bilinmesine rağmen literatürde tedavi sonrası tromboz gelişen olgular bildirilmektedir. Kronik İTP tanısı ile takipli, bir ay önce İVİG uygulanmış 62 yaşında kadın hasta, alt extremitede şişlik ve nefes darlığı ile başvurdu. Alt ekstremite doppler ultrasonografisinde sol popliteal-femoral vende trombüs ve toraks tomografisinde bilateral pulmoner arterlerde trombüs izlendi. Hemodinamisi bozulan hastaya trombolitik tedavi yapma kararı verildi ancak trombositopenisi (38.000/mm3) mevcuttu. Trombosit transf üzyonu ile beraber rekombinan doku plazminojen aktivatör (t-PA 100mg) uygulandı. Komplikasyon gelişmeyen hastada tromboz etiyolojisine yönelik yapılan edinsel ve kalıtsal testlerde bir patoloji saptanmadı. Yalnızca etiyolojik ajan olarak İVİG kullanımı vardı. Olgumuz; İTP'da İVİG tedavisi ve tromboz birlikteliğine dikkat çekmek, yaşamı tehdit eden masif pulmoner tromboemboli durumunda kanama diyatezi açısından gerekli destek tedavi yapılarak trombolitik tedavi uygulanabilece ğini vurgulamak amacıyla literatür bilgileri eşli- ğinde sunulmuştur.

Anahtar Kelimeler

• İmmun trombositopenik purpura, intravenöz immunglobulin, pulmoner emboli, trombolitik tedavi

THROMBOLYTIC TREATMENT IN A CASE OF PULMONARY THROMBOEMBOLISM SUBSEQUENT TO IVIG THERAPY FOR IMMUNE THROMBOCYTOPENIC PURPURA

Abstract

Immune thrombocytopenic purpura (ITP) is an otoimmune disease, characterised by the demolition of trombocytes coated with antibodies against glicoprotein IIb/IIIa. Intravenous immunoglobulin (IVIG), is known to be an effective and reliable therapy in cases of life endangering, bleeding, chronic ITP, however here are few cases of thrombosis reported in literature after use of this therapy approach. 62 year old female patient, with a history of chronic ITP and IVIG treatment a month ago, presented with swelling in lower extremities and difficulty in breathing. Doppler ultrasonography of lower extremities showed thrombus in left popliteal femoral vein and thorax tomography revealed several thrombuses in bilateral pulmonary arteries. Thrombolytıc therapy is planned to the patient with hemodynamic instabiliy but the patient had thrombocytopenia (38.000/mm3). Trombocyte transfusion combined with tissue plasminogen activator (t-PA) was chosen as the therapy approach. No complication occurred and no pathology showed at acquired and genetic test results. Etiologic agent was only IVIG treatment. Our case is presented along with medical literature to take attention at the association of IVIG therapy for ITP and thrombosis occurrence and to highlight the use of support therapy with thrombolytic agents in such cases.

Keywords

• Immune thrombocytopenic purpura, ıntravenous ımmunoglobuline, pulmonary embolism, thrombolytıc therapy

Kaynakça

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