İmmun Trombositopenik Purpura Tanılı Çocuklarda İntravenöz İmmunoglobulin Tedavisini Etkileyen Prognostik Faktörler ve Tedavinin Kronikleşme Üzerine Etkisi

GİRİŞ ve AMAÇ: İmmun Trombositopeni (İTP) tanılı çocuklarda intravenöz immunoglobulin tedavisini etkileyen prognostik faktörler ve tedavinin kronikleşme üzerine etkisi belirlenmek istenmiştir. YÖNTEM ve GEREÇLER: Çalışmaya; 2010-2016 yılları arasında başvuran, 3 ay- 16 yaş aralığındaki 80 hasta alınmıştır. Her hastanın cinsiyeti, yaşı, tanı öncesin varsa enfeksiyon ve aşılanma öyküsü, kanama bulguları, tanı anındaki laboratuvar değeri, IVIG tedavisine yanıt süresi, tanıdan 1 yıl sonraki trombosit değeri incelenmiştir. Akut ve kronik İTP tanısı alan gruplar arasında veriler karşılaştırılmıştır. BULGULAR: İTP tanısı alan ve IVIG tedavisi verilen 80 olgunun sosyodemografik ve laboratuvar özellikleri değerlendirildi. Yaş ortalaması 71,40±46,18 ay idi. Olgularımızda erkek/kız oranı 1,0 olarak tespit edildi. 32 olguda başvurudan önceki 6 hafta içerisinde, viral enfeksiyon geçirme öyküsü vardı. Akut İTP’ lerin %11 inde trompositopeni gelişmeden önceki 6 hafta içinde aşı olma öyküsü varken kronik İTP ‘lerde son 6 hafta içinde aşı öyküsü saptanmadı. Akut İTP olgularının en çok sonbahar aylarında, kronik İTP olgularının ön planda kış ve yaz aylarında tanı aldığı görüldü. Tüm hastaların ortalama trombosit sayıları,WBC, MPV, PDW, PCT, CRP, PT, aPTT değerleri değerlendirildiğinde benzer sonuçlar elde edildi (p>0.05). TARTIŞMA ve SONUÇ: İmmun Trombositopeni’de kronikleşmeyi ön görebilmek için demografik özellikler, klinik bulgular, laboratuvar bulguları ve tedavi şekillerinden ziyade otoantikorlar ve immun trompositopeninin genetik mekanizmalarına yönelik ileri çalışmalara ihtiyaç olduğunu saptadık.

Anahtar Kelimeler:

immun trombositopeni, çocuk, IVIG, prognostik faktörler

Prognostic Factors Affecting Intravenous Immunglobulin Therapy in Children Diagnosed Immune Thrombocytopenic Purpura and Effect of Treatment on Chronicity

INTRODUCTION: Main purpose of this study is to evaluate the prognostic factors affecting intravenous immunglobulin therapy in children diagnosed immune thrombocytopenic purpura and effect of treatment on chronicity.METHODS: 80 children who are 3 months-16 years old diagnosed with immune thrombocytopenia during 2000-2016 were included in this study. The gender of each patient, age, history of infection and vaccination before diagnosis, bleeding findings, laboratory values at diagnosis, duration of response to IVIG treatment, and thrombocyte counts after 1 year were examined. Data were compared between acute and chronic ITP groups.RESULTS: Sociodemographic and laboratory characteristics of totally 80 children were evaluated. The average age of children was 71.40±46.18 months. In our cases, the ratio of male to female was 1,0. Thirty two of our cases (53.33%) had a history of viral infection within 6 weeks prior to admission. 11% of acute ITPs had a story of vaccination within 6 weeks prior to thrombocytopenia, whereas no vaccination was detected within 6 weeks of chronic ITP. Acute ITP was diagnosed in 22 cases in autumn at most, and chronic ITP was diagnosed in 7 cases in winter and summer months. Similar results were obtained when tthe mean platelet counts, WBC, MPV, PDW, PCT, CRP, PT, aPTT values of the patients were evaluated. DISCUSSION AND CONCLUSION: We need further studies on the genetic mechanism and autoantibodies in immune thrombocytopenia with respect to demographics, clinical findings, laboratory findings and treatment modalities to predict chronicity

Keywords:

immune thrombocytopenia, childhood, IVIG, prognostic factors,

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