Çocukluk Çağı İmmün Trombositopenik Purpura (İTP) Hastalarının Yaş Gruplarına Göre Değerlendirilmesi

Yıl 2021, Cilt: 16 Sayı: 3, 350 - 356, 01.11.2021

Muhammed Parlar Can Acıpayam , Serpil Dinçer , Ufuk Utku Güllü Mustafa Çobanuşağı , Hüsnü Maraşlı

https://doi.org/10.17517/ksutfd.811899

Cited By: 1

Öz

Amaç: İmmün trombositopeni (İTP), artmış kanama riskine neden olabilen, trombosit sayısının azalması ile karakterize otoimmün bir hastalıktır. Çalışmamızda İTP hastalarının yaş gruplarına göre değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Eylül 2014 ile Ocak 2019 tarihleri arasında İTP tanısı alan hastalar 3-24 ay, 2-10 yaş ve 10-18 yaş olarak gruplandırıldı. Gruplar demografik özelliklerine, laboratuvar verilerine, tedavi şekillerine, tedaviden 12 ay sonraki trombosit sayılarına, tedavi direncine ve kronikleşme durumuna göre karşılaştırıldı.
Bulgular: Çalışmaya İTP tanısı alan 104 hastanın 95’i dahil edildi. Hastaların 28’i 3-24 ay, 41’i 2-10 yaş ve 26’sı 10-18 yaş aralığındaydı. Hastalar IVIG, steroid ve IVIG ile steroid birlikte verilerek tedavi edildi. Yaş ilerledikçe sadece steroidle tedavi sıklığının arttığı görüldü (p=0,030). Kronikleşen hasta sayısı 37 idi. Hastalığın 10 yaş üzerinde görülmesi (p<0,001), hastanın tanı anındaki trombosit sayısının ≥20 x10³/mm³ olması (p=0,002) ve hastalara sadece steroid tedavisi verilmesi (p<0,031) tedavi sonrası kronikleşmeyi etkileyen ve istatistiksel olarak anlamlı olan risk faktörleriydi.
Sonuç: Çalışmada hastaların 54’ü erkekti. Hastalar 2-10 yaş grubunda daha fazlaydı. Hastaların 37’si kronikleşti. 10-18 yaş grubunda tedaviye direnç ve kronikleşme durumu daha fazlaydı.

Anahtar Kelimeler

İmmun trombositopeni, çocukluk çağı, tedavi, direnç, kronikleşme

Evaluation of Childhood Immune Trombocytopenic Purpura (ITP) Patients According to Age Groups

Öz

Objective: Immune thrombocytopenia is an autoimmune disease characterised by decreased platelet count, which can cause increased bleeding risk. In our study, it was aimed to compare patients with immune thrombocytopenia according to their age groups
Material and Methods: Patients diagnosed with immune thrombocytopenia between September 2014 and January 2019 were divided into groups as 3-24 months, 2-10 years and 10-18 years. The groups were evaluated statistically according to demographic features, laboratory data, treatment modalities, platelet counts 12 months after treatment, resistance to treatment and chronicization states.
Results: In this study, 95 of 104 patients diagnosed with ITP were included. There were 28 patients in the group between 3-24 months, 41 patients in the group between 2-10 years old and 26 patients in the group between 10-18 years old in the study. Patients were treated with IVIG, steroids and IVIG combined with steroids. It was observed that the frequency of steroid treatment alone increased with age (p=0.030). The number of chronic patients was 37. The appearance of the disease over the age of 10 (p<0.001), the platelet count of the patient at the time of diagnosis was ≥20 x10³/mm³ (p=0,002) and treatment of steroid alone (p<0,031) were risk factors that affect chronicization after treatment and statistically significant.
Conclusion: In this study, 54 patients were male. The count of cases was higher in the 2-10 age group. 37 of the patients became chronic. Treatment resistance and chronic status were highest in the 10-18 age group.

Anahtar Kelimeler

Immune thrombocytopenia, childhood, treatment, resistance, chronicization

Kaynakça

• 1. Shih A, Nazi I, Kelton JG, Arnold DM. Novel treatments for immune thrombocytopenia. Presse Med. 2014;43(4 Pt 2):e87-95.
• 2. Kühne T. Diagnosis and management of immune thrombocytopenia in childhood. Hamostaseologie. 2017;37(1):36-44.
• 3. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-86.
• 4. Kalyoncu D, Yildirmak Y, Cetinkaya F. Comparison of idiopathic thrombocytopenic purpura in children between 3 months and 2 years versus 2-5 years. Pediatr Blood Cancer. 2009;52(5):656-8.
• 5. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386-93.Kado R, McCune WJ. Treatment of primary and secondary immune thrombocytopenia. Curr Opin Rheumatol. 2019;31(3):213-222.
• 6. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA; American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.
• 7. Buchanan GR, Adix L. Grading of hemorrhage in children with idiopathic thrombocytopenic purpura. J Pediatr. 2002;141(5):683-8.
• 8. Paling A, Stefan DC. Idiopathic thrombocytopenic purpura in childhood: a 10-year audit. Hematology. 2008;13(3):175-80.
• 9. Güngör T, Arman Bilir Ö, Koşan Çulha V, Güngör A, Kara A, Azık FM, et al. Retrospective evaluation of children with immune thrombocytopenic purpura and factors contributing to chronicity. Pediatr Neonatol. 2019;60(4):411-416.
• 10. Heitink-Pollé KM, Nijsten J, Boonacker CW, de Haas M, Bruin MC. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis. Blood. 2014;124(22):3295-307.
• 11. Mitura-Lesiak M, Filiks-Litwin B, Malek U, Kowalczyk JR. Clinical course, diagnostic and therapeutic management of immune thrombocytopenic purpura in children. Med Wieku Rozwoj. 2004;8(4 Pt 1):1004-11.
• 12. Miri-Aliabad G, Rashidi S. Immune Thrombocytopenic Purpura and Hemolytic Anemia Secondary to Hepatitis A. Int J Hematol Oncol Stem Cell Res. 2017;11(2):89-91.
• 13. Zhang YD, Hu Q, Liu SY, Liu AG, Wang GL, Xiong H, et al. Association of human parvovirus B19 infection and childhood idiopathic thrombocytopenic purpura: a meta analysis of Chinese literatures. Zhongguo Dang Dai Er Ke Za Zhi. 2009;11(12):999-1001.
• 14. Morin E, Sadarangani M. Recurrent immune thrombocytopenia following different vaccines. BMJ Case Rep. 2019;12(9):e231260.
• 15. Akbayram S, Akgun C, Dogan M, Caksen H, Oner AF. Acute ITP due to insect bite: report of 2 cases. Clin Appl Thromb Hemost. 2011;17(4):408-9.
• 16. Rodeghiero F, Michel M, Gernsheimer T, Ruggeri M, Blanchette V, Bussel JB, et al. Standardization of bleeding assessment in immune thrombocytopenia: report from the International Working Group. Blood. 2013;121(14):2596-606.
• 17. Janus J, Moerschel SK. Evaluation of anemia in children. Am Fam Physician.2010;81(12):1462-71.
• 18. Hung GY, Lee CY, Yen HJ, Lin LY, Horng JL. Incidence of immune thrombocytopenia in Taiwan: a nationwide population-based study. Transfusion. 2018;58(11):2712-2719.
• 19. Watts RG. Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama. Clin Pediatr (Phila). 2004;43(8):691-702.
• 20. Lee E, Kim M, Jeon K, Lee J, Lee JS, Kim HS, et al. Mean Platelet Volume, Platelet Distribution Width, and Platelet Count, in Connection with Immune Thrombocytopenic Purpura and Essential Thrombocytopenia. Lab Med. 2019;50(3):279-285.
• 21. Bussel JB, Provan D, Shamsi T, Cheng G, Psaila B, Kovaleva L, et al. Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373(9664):641-8.
• 22. Heitink-Pollé KM, Nijsten J, Boonacker CW, de Haas M, Bruin MC. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis. Blood. 2014;124(22):3295-307.