Coagulation parameters in children with acute immune thrombocytopenic purpura

İmmun trombositopenik purpura (İTP) çocukluk çağındaki en sık hemorajik diyatez sebeplerinden biridir. Bu çalışmamızda, akut İTP'li çocuklarda koagulasyon parametrelerinde bir değişiklik olup olmadığını ve uygulanan farklı tedavi modellerinin bu parametreler üzerine olan etkisini araştırdık. Akut İTP tanısı alan 21 hasta bu çalışmaya dahil edildi. Hastalar randomize bir şekilde intravenöz immun globulin (İVİG) veya yüksek doz -pulse- metil prednizolon (PMP) ile tedavi edildiler. Tanı anında tüm hastalarda kanama zamanı (KZ), protrombin zamanı (PZ), aktive parsiyel tromboplastin zamanı (APTZ), fibrinojen ve von Willebrand Faktör: Ristosetin Kofaktör Aktivitesi (vWF:RCoF) çalışıldı. Ayrıca tanıda ve tedavi sonrasında tüm hastalarda protein C (PC), serbest protein S (f-PS), antitrombin (AT), D-dimer (DD), protrombin fragman 1+2 (PF 1+2) ve lupus antikoagulanı (LA) test edildi. İVİG ile tedavi edilen hasta grubunda güvenli trombosit sayılarına PMP grubuna göre daha hızlı ulaşıldığı görüldü. Tanı anında hastaların AT ve PF 1+2 düzeyleri sağlıklı gruba göre anlamlı olarak daha yüksek iken (p=0.0001) DD düzeyleri anlamlı olarak düşük (p=0.0001) bulundu. Tanı anında 9 hastada (% 41) LA pozitif bulundu. Tedavi sonrasındaki PC, f-PS ve AT düzeyleri İVİG grubu ile karşılaştırıldığında PMP grubunda anlamlı olarak daha yüksek bulundu (sırasıyla p=0.004, 0.001, 0.017) Bu veriler akut İTP'li çocuklarda trombositopeni yanında koagulayon ve fibrinolitik sistemde de bazı reaktif değişikliklerin olduğunu göstermektedir. Değişik tedavi modellerinin bu parametreler üzerindeki etkileri farklı olabilmektedir.

Akut immun trombositopenik purpura tanılı çocuklarda koagulasyon parametreleri

Immune thrombocytopenic purpura (ITP) is one of the most common causes of hemorrhagic diathesis during childhood. In this study, we investigated whether there is a change in the coagulation parameters and the effects of different treatment regimens on these parameters in children with acute ITP. Twenty one acute ITP patients were enrolled in the study. Patients were treated randomly with either intravenous immune globulin (IVIG) or intravenous pulsemethylprednisolone (PMP). Bleeding time (BT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, von Willebrand factor: ristocetin cofactor activity (vWF:RCoF) were tested at diagnosis. Protein C (PC), freeprotein S (f-PS), antithrombin (AT), D-dimer (DD), prothrombin fragment 1+2 (PF 1+2) and lupus anticoagulant (LA) were measured in the patients at diagnosis and after the treatment. Adequate platelet levels were obtained more rapidly in patients treated with IVIG than with PMP. At diagnosis, while AT and PF 1+2 levels were found significantly higher (p=0.0001) in the patients, DD level was significantly lower (p=0.0001). Nine patients (41 %) had LA positivity at diagnosis. After treatment, levels of PC, f-PS and AT increased significantly in PMP group when compared to IVIG group (p=0.004, 0.001, 0.017 respectively). These data show that there are some reactive changes in coagulation and fibrinolytic systems in addition to thrombocytopenia in acute ITP. Different therapy modalities may affect these parameters differently.

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