İmmün Trombositopenik Purpura Hastalarının Retrospektif Analizi

Yıl 2020, Cilt: 10 Sayı: 2, 196 - 200, 25.06.2020

Şengül Aksakal Düzgün Özatlı Mehmet Turgut Nil Guler

https://doi.org/10.16899/jcm.734474

Öz

Amaç: Kronik immün trombositopenik purpura (ITP) tanısı konan ve/veya izlenen hastaların klinik özellikleri ve tedavi yanıtları değerlendirdik.
Yöntemler: Ondokuz Mayıs Tıp Fakültesi'nde 2003-2011 yılları arasında ITP tanısı konan ve/veya takibi yapılan 150 hastanın tıbbi kayıtları geriyedönük incelendi. Birinci basamak tedavi olarak steroid bazlı tedavi ve IVIg kullanıldı. Birinci ve ikinci basamak tedavilerine cevap vermeyen hastalara splenektomi uygulandı.
Bulgular: 150 hastanın ortanca takip süresi 15 ay (aralık 2-83 ay) idi. Olguların 51'inde (%34) trombositopeni tesadüfen saptanmıştı. Çalışma süresi boyunca 21 (%14) hasta tedavisiz takip edildi. 129 hastaya (%86) birinci basamak tıbbi tedavi verildi. Bunlardan 93'ünde (%72) tam yanıt (14), 14'ünde (%11) kısmi yanıt (PR) ve 22 (%17) hastada herhangi bir yanıt görülmedi (NR). Yüksek doz steroid tedavisinin standart doz tedavisine göre anlamlı bir faydası yoktu (p = 0,59). Tedaviye yanıt veren 107 hastanın 2,5'inde 48 (%45) nüks görüldü. 40 hastanın 15'inde (%38) CR, 9'unda (%22) PR ve 16'sında (%40) NR vardı. 38 hastaya splenektomi uygulandı. 48 hastadan 32'sinde (%84) CR, 2'sinde (%5) PR ve 4'ünde (%16) NR elde edildi. On iki hastada (%35) nüks görüldü.
Sonuç: Bu çalışma ITP hastalarında steroid bazlı tedavi ve splenektominin çok etkili bir tedavi olduğunu göstermiştir. Çalışmamızda sadece 13 (%8,6) hasta daha ileri tedaviye ihtiyaç duydu.

Anahtar Kelimeler

İmmün Trombositopenik Purpura, kanama, kortikosteroid, splenektomi

Retrospective Analysis of Patients with Immune Thrombocytopenic Purpura

Öz

Aim: We evaluated the clinical feature and the responses to treatments in patients diagnosed and/or followed as chronic immune thrombocytopenic purpura (ITP).
Methods: Medical charts of 150 patients diagnosed and/or followed as ITP at Ondokuz Mayıs Medical Faculty between 2003 and 2011 were analyzed retrospectively. As first-line treatments, steroids based treatment and IVIg were used as medical therapy. In patients, who had no response to first and second courses treatments, splenectomy was performed.
Results: The median follow-up of 150 patients was 15 months (range 2-83 months). Thrombocytopenia was incidentally detected in 51(34%) of the cases. During the study period, 21(14%) the patients were followed up without treatment. First line medical therapy were given to 129(86%) patients. Of them, complete response (CR) were seen in 93(72%) patients, partial response (PR) in 14(11%) patients and none response (NR) in 22 (17%) patients. There was no significant benefit of high dose steroid therapy over the standard dose therapy (p=0.59). Of the 107 patients who had response to the treatment, relapse were observed in 48(45%) within 2,5 years. Of 40 patients, there were CR in 15(38%) patients, PR in 9(22%) patients and NR in 16(40%) patients. Splenectomy was performed in 38 patients. Of the 48 patients, CR was achieved in 32(84%) patients, PR in 2(%5) patients and NR in 4(16%) patients. Relapse was observed in 12(35%) patients.
Conclusion: This study showed that steroids based treatment and splenectomy are very effective treatment in ITP patients. Only 13(8.6%) patients in our study needed further treatment.

Anahtar Kelimeler

Immune Thrombocytopenic Purpura, Bleeding, corticosteroid, splenectomy

Kaynakça

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