İdiyopatik Trombositopenik Purpura Nedeniyle Takip ve Tedavi Edilen Hastaların Retrospektif Değerlendirmesi: Tek Merkez 21 Yıllık Deneyimi
Öz
Giriş: Primer immün trombositopeni (ITP), altta yatan başka bir neden olmaksızın düşük trombosit sayısı (<100×109/L) ile ayırt edilen otoimmün bir hastalıktır. Bu çalışmanın amacı kliniğimizde idiyopatik trombositopenik purpura nedeniyle takip edilen hastaların demografik özelliklerini, muayene bulgularını, laboratuvar sonuçlarını, tedavi rejimlerini ve tedaviye yanıtlarını retrospektif olarak değerlendirerek kronikleşmeyi etkileyen faktörleri belirlemektir.
Materyal ve metot: Bu çalışmada, 1 Ocak 1997 ile 31 Aralık 2018 tarihleri arasında Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı'na başvuran ve idiyopatik trombositopenik purpura tanısı alan hastaların tıbbi kayıtları retrospektif olarak incelendi.
Bulgular: Ocak 1997-Aralık 2018 tarihleri arasında idiyopatik trombositopenik purpura (İTP) tanısı alan toplam 447 hasta belirlendi. Dört yüz yirmi sekiz hasta çalışmaya dahil edildi. Kronik İTP'de ortalama tanı yaşı akut İTP'ye göre daha yüksekti (p=0.000). Başvuru sırasındaki trombosit sayısı akut İTP hastalarında kronik İTP hastalarına göre daha düşüktü (p=0,035). ANA pozitifliği kronik hastalarda diğer gruplara göre çok daha yüksekti (p=0.014). Tanı anındaki ve 3. gündeki trombosit sayısı arasındaki fark, steroid ve IVIG tedavisi gören hastalarda kombine tedavi gören hastalara göre çok daha yüksekti (p<0.001). Remisyona giren hastaların 3. ve 7. gün trombosit sayıları remisyona girmeyen hastalarınkinden daha yüksekti (p<0.001). Tanı yaşı, ortalama takip süresi ve 7. gün trombosit sayısı kronikleşme için risk faktörleri olarak belirlendi.
Sonuç: İleri tanı yaşı, kız cinsiyet, üst solunum yolu enfeksiyonu öyküsünün olmaması ve yüksek trombosit sayısının İTP'li çocuklarda kronikleşmeyi etkileyen faktörler olduğu bulunmuştur.
Anahtar Kelimeler
Destekleyen Kurum
Bu araştırma kamu, ticari veya kar amacı gütmeyen kuruluşlardan herhangi bir özel destek almamıştır.
Kaynakça
- Fan QX, Wang CM, Chen SX, Liu XG, Han B. Immune Thrombocytopenic Purpura in Children of Eastern Henan Province, China. Indian Pediatr. 2016;53(11):1024-5.
- Lee AC. Isolated thrombocytopenia in childhood: what if it is not immune thrombocytopenia? Singapore Med J. 2018;59(7):390-3.
- Makis A, Gkoutsias A, Palianopoulos T, Pappa E, Papapetrou E, Tsaousi C, et al. Prognostic Factors for Immune Thrombocytopenia Outcome in Greek Children: A Retrospective Single-Centered Analysis. Adv Hematol. 2017;2017:7878605.
- 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.
- Grace RF, Neunert C. Second-line therapies in immune thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2016;2016(1):698-706.
- 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):411-6.
- ElAlfy M, Farid S, Abdel Maksoud A. Predictors of chronic idiopathic thrombocytopenic purpura. Pediatr Blood Cancer. 2010;54(7):959-62.
- Mcguinn C, Bussel J. Disorders of Platelets. U: Lanzkowsky's Manual of Pediatric Hematology and Oncology. Elsevier academic press; 2016.
- Chotsampancharoen T, Sripornsawan P, Duangchoo S, Wongchanchailert M, McNeil E. Clinical outcome of childhood chronic immune thrombocytopenia: A 38-year experience from a single tertiary center in Thailand. Pediatr Blood Cancer. 2017;64(11).
- Zeller B, Rajantie J, Hedlund-Treutiger I, Tedgård U, Wesenberg F, Jonsson OG, et al. Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acta Paediatr. 2005;94(2):178-84.
- Evim MS, Baytan B, Güneş AM. Childhood Immune Thrombocytopenia: Long-term Follow-up Data Evaluated by the Criteria of the International Working Group on Immune Thrombocytopenic Purpura. Turk J Haematol. 2014;31(1):32-9.
- Kim CY, Lee EH, Yoon HS. High Remission Rate of Chronic Immune Thrombocytopenia in Children: Result of 20-Year Follow-Up. Yonsei Med J. 2016;57(1):127-31.
- Roganovic J, Letica-Crepulja M. Idiopathic thrombocytopenic purpura: a 15-year natural history study at the Children's Hospital Rijeka, Croatia. Pediatric blood & cancer. 2006;47(5 Suppl):662-4.
- Kubota M, Adachi S, Usami I, Okada M, Kitoh T, Shiota M, et al. Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study. Int J Hematol. 2010;91(2):252-7.
- Nugent D. Immune thrombocytopenic purpura of childhood. Hematology American Society of Hematology Education Program. 2006:97-103.
- Tombak A, Boztepe B, Tiftik N, Cömert M, Salim O, Aydın K, et al. Seasonal Association of Immune Thrombocytopenia in Adults. Balkan Med J. 2015;32(4):347-51.
- Rosthøj S, Nielsen S, Pedersen FK. Randomized trial comparing intravenous immunoglobulin with methylprednisolone pulse therapy in acute idiopathic thrombocytopenic purpura. Danish I.T.P. Study Group. Acta Paediatr. 1996;85(8):910-5.
- Hafiz MG, Mannan MA, Amin SK, Islam A, Rahman F. Immune thrombocytopenic purpura among the children attending at two teaching hospitals. Bangladesh Med Res Counc Bull. 2008;34(3):94-8.
- Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Lancet. 2001;358(9299):2122-5.
- Altintas A, Ozel A, Okur N, Okur N, Cil T, Pasa S, et al. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis. 2007;24(2):163-8.
- Liu Q, Xu H, Guan X, Shen Y, Wen X, Guo Y, et al. Clinical Significance of Antinuclear and Antiextractable Nuclear Antigen Antibody in Childhood Immune Thrombocytopenia. Semin Thromb Hemost. 2017;43(6):629-34.
- Grimaldi-Bensouda L, Nordon C, Leblanc T, Abenhaim L, Allali S, Armari-Alla C, et al. Childhood immune thrombocytopenia: A nationwide cohort study on condition management and outcomes. Pediatr Blood Cancer. 2017;64(7).
- Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.
- Mithoowani S, Arnold DM. First-Line Therapy for Immune Thrombocytopenia. Hamostaseologie. 2019;39(3):259-65.
- Glanz J, France E, Xu S, Hayes T, Hambidge S. A population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children. Pediatrics. 2008;121(3):e506-12.
- Tamminga R, Berchtold W, Bruin M, Buchanan GR, Kühne T. Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS). Br J Haematol. 2009;146(2):180-4.
- Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C. Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. J Pediatr. 2005;147(4):521-7.
- Bruin M, Bierings M, Uiterwaal C, Révész T, Bode L, Wiesman ME, et al. Platelet count, previous infection and FCGR2B genotype predict development of chronic disease in newly diagnosed idiopathic thrombocytopenia in childhood: results of a prospective study. Br J Haematol. 2004;127(5):561-7.
- Celik M, Bulbul A, Aydogan G, Tugcu D, Can E, Uslu S, et al. Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura. Journal of Thrombosis and Thrombolysis. 2013;35(2):228-33.
- Bennett CM, Neunert C, Grace RF, Buchanan G, Imbach P, Vesely SK, et al. Predictors of remission in children with newly diagnosed immune thrombocytopenia: Data from the Intercontinental Cooperative ITP Study Group Registry II participants. Pediatr Blood Cancer. 2018;65(1).
- Nagrebetsky A, Al-Samkari H, Davis NM, Kuter DJ, Wiener-Kronish JP. Perioperative thrombocytopenia: evidence, evaluation, and emerging therapies. Br J Anaesth. 2019 Jan;122(1):19-31
Retrospective Evaluation of Patients Followed-Up and Treated for Idiopathic Thrombocytopenic Purpura: A 21-Year Single-Center Experience
Öz
Introduction: Primary immune thrombocytopenia (ITP) is an autoimmune disorder that is distinguished by a low platelet count (<100×109/L) without any other underlying causes. The aim of this study is to determine the factors affecting chronicity by retrospectively evaluating the demographic characteristics, examination findings, laboratory results, treatment regimens and treatment responses of patients followed-up for idiopathic thrombocytopenic purpura in our clinic.
Materials and methods: This study retrospectively reviewed the medical records of patients diagnosed with idiopathic thrombocytopenic purpura and admitted to the Department of Paediatrics at the Faculty of Medicine from January 1, 1997, to December 31, 2018.
Results: A total of 447 patients diagnosed with idiopathic thrombocytopenic purpura (ITP) between January 1997-December 2018 were identified. Four hundred twenty-eight patients were included in the study. The mean age of diagnosis in chronic ITP was higher than that of acute ITP (p=0.000). Platelet count at admission was lower in acute ITP patients than that of chronic patients (p=0.035). ANA positivity was much higher among chronic patients than in other groups (p=0.014). The difference between the platelet count at the time of diagnosis and on the 3rd day was much higher in patients on steroid and IVIG therapy than that of the patients under combined therapy (p<0.001). The 3rd and 7th-day platelet counts of patients with remission was higher than that of the patients without remission (p<0.001). Age of diagnosis, mean follow-up period, and platelet count at day 7 were identified as the risk factors for chronicity.
Conclusion: It was found that older age of diagnosis, female sex, absence of upper respiratory tract infections history, high platelet count were the factors affecting chronicity in children with ITP.
Keywords: Immune thrombocytopenic purpura, child, thrombocytopenia
Anahtar Kelimeler
Destekleyen Kurum
This research did not get any dedicated support from public, commercial, or not-for-profit organisations.
Kaynakça
- Fan QX, Wang CM, Chen SX, Liu XG, Han B. Immune Thrombocytopenic Purpura in Children of Eastern Henan Province, China. Indian Pediatr. 2016;53(11):1024-5.
- Lee AC. Isolated thrombocytopenia in childhood: what if it is not immune thrombocytopenia? Singapore Med J. 2018;59(7):390-3.
- Makis A, Gkoutsias A, Palianopoulos T, Pappa E, Papapetrou E, Tsaousi C, et al. Prognostic Factors for Immune Thrombocytopenia Outcome in Greek Children: A Retrospective Single-Centered Analysis. Adv Hematol. 2017;2017:7878605.
- 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.
- Grace RF, Neunert C. Second-line therapies in immune thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2016;2016(1):698-706.
- 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):411-6.
- ElAlfy M, Farid S, Abdel Maksoud A. Predictors of chronic idiopathic thrombocytopenic purpura. Pediatr Blood Cancer. 2010;54(7):959-62.
- Mcguinn C, Bussel J. Disorders of Platelets. U: Lanzkowsky's Manual of Pediatric Hematology and Oncology. Elsevier academic press; 2016.
- Chotsampancharoen T, Sripornsawan P, Duangchoo S, Wongchanchailert M, McNeil E. Clinical outcome of childhood chronic immune thrombocytopenia: A 38-year experience from a single tertiary center in Thailand. Pediatr Blood Cancer. 2017;64(11).
- Zeller B, Rajantie J, Hedlund-Treutiger I, Tedgård U, Wesenberg F, Jonsson OG, et al. Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acta Paediatr. 2005;94(2):178-84.
- Evim MS, Baytan B, Güneş AM. Childhood Immune Thrombocytopenia: Long-term Follow-up Data Evaluated by the Criteria of the International Working Group on Immune Thrombocytopenic Purpura. Turk J Haematol. 2014;31(1):32-9.
- Kim CY, Lee EH, Yoon HS. High Remission Rate of Chronic Immune Thrombocytopenia in Children: Result of 20-Year Follow-Up. Yonsei Med J. 2016;57(1):127-31.
- Roganovic J, Letica-Crepulja M. Idiopathic thrombocytopenic purpura: a 15-year natural history study at the Children's Hospital Rijeka, Croatia. Pediatric blood & cancer. 2006;47(5 Suppl):662-4.
- Kubota M, Adachi S, Usami I, Okada M, Kitoh T, Shiota M, et al. Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study. Int J Hematol. 2010;91(2):252-7.
- Nugent D. Immune thrombocytopenic purpura of childhood. Hematology American Society of Hematology Education Program. 2006:97-103.
- Tombak A, Boztepe B, Tiftik N, Cömert M, Salim O, Aydın K, et al. Seasonal Association of Immune Thrombocytopenia in Adults. Balkan Med J. 2015;32(4):347-51.
- Rosthøj S, Nielsen S, Pedersen FK. Randomized trial comparing intravenous immunoglobulin with methylprednisolone pulse therapy in acute idiopathic thrombocytopenic purpura. Danish I.T.P. Study Group. Acta Paediatr. 1996;85(8):910-5.
- Hafiz MG, Mannan MA, Amin SK, Islam A, Rahman F. Immune thrombocytopenic purpura among the children attending at two teaching hospitals. Bangladesh Med Res Counc Bull. 2008;34(3):94-8.
- Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Lancet. 2001;358(9299):2122-5.
- Altintas A, Ozel A, Okur N, Okur N, Cil T, Pasa S, et al. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis. 2007;24(2):163-8.
- Liu Q, Xu H, Guan X, Shen Y, Wen X, Guo Y, et al. Clinical Significance of Antinuclear and Antiextractable Nuclear Antigen Antibody in Childhood Immune Thrombocytopenia. Semin Thromb Hemost. 2017;43(6):629-34.
- Grimaldi-Bensouda L, Nordon C, Leblanc T, Abenhaim L, Allali S, Armari-Alla C, et al. Childhood immune thrombocytopenia: A nationwide cohort study on condition management and outcomes. Pediatr Blood Cancer. 2017;64(7).
- Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.
- Mithoowani S, Arnold DM. First-Line Therapy for Immune Thrombocytopenia. Hamostaseologie. 2019;39(3):259-65.
- Glanz J, France E, Xu S, Hayes T, Hambidge S. A population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children. Pediatrics. 2008;121(3):e506-12.
- Tamminga R, Berchtold W, Bruin M, Buchanan GR, Kühne T. Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS). Br J Haematol. 2009;146(2):180-4.
- Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C. Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. J Pediatr. 2005;147(4):521-7.
- Bruin M, Bierings M, Uiterwaal C, Révész T, Bode L, Wiesman ME, et al. Platelet count, previous infection and FCGR2B genotype predict development of chronic disease in newly diagnosed idiopathic thrombocytopenia in childhood: results of a prospective study. Br J Haematol. 2004;127(5):561-7.
- Celik M, Bulbul A, Aydogan G, Tugcu D, Can E, Uslu S, et al. Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura. Journal of Thrombosis and Thrombolysis. 2013;35(2):228-33.
- Bennett CM, Neunert C, Grace RF, Buchanan G, Imbach P, Vesely SK, et al. Predictors of remission in children with newly diagnosed immune thrombocytopenia: Data from the Intercontinental Cooperative ITP Study Group Registry II participants. Pediatr Blood Cancer. 2018;65(1).
- Nagrebetsky A, Al-Samkari H, Davis NM, Kuter DJ, Wiener-Kronish JP. Perioperative thrombocytopenia: evidence, evaluation, and emerging therapies. Br J Anaesth. 2019 Jan;122(1):19-31
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi (Diğer) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2023 |
| Gönderilme Tarihi | 11 Aralık 2023 |
| Kabul Tarihi | 19 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 2 Sayı: 3 |
