PANSİTOPENİ / BİSİTOPENİSİ OLAN ÇOCUKLARIN KLİNİK VE ETİYOLOJİK AÇIDAN DEĞERLENDİRİLMESİ

Giriş: Pansitopeni ve bisitopeni, çocukluk çağında sık karşılaşılan önemli klinik durumlardır. Benign ya da malignnedenlere bağlı olarak görülebilmektedirler. Bu çalışmada pansitopeni ve bisitopenisi olan hastaların klinik velaboratuvar olarak değerlendirilmesi ve etiyolojik nedenlerin belirlenmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2018-Ocak 2020 tarihleri arasında Çocuk Hematoloji Bölümü’nde izlenen, yaşları 3 ay18 yaş arasında olan, yeni ortaya çıkan pansitopeni/bisitopenisi olan 108 hasta çalışmaya alındı. Hastalarındetaylı öykü, fizik muayene bulguları, periferik yayma ve kemik iliği incelemesi de dahil laboratuvar bulgularıkaydedildi.Bulgular: Hastalarda kız/erkek oranı 56/52, yaş ortalaması 6,2 yıl idi. Hastaların 67’sinde (%62) bisitopeni,41’inde (%38) pansitopeni mevcuttu. En sık başvuru yakınmaları ateş (%63,9), halsizlik (%28,7) ve solunum yoluenfeksiyonu semptomları (%20,3) idi. Fizik muayenede en sık saptanan bulguların solukluk (%50), hepatomegali(%27,8) ve splenomegali (%26,8) olduğu görüldü. Hastaların %86’sında trombositopeni, %76,9’unda anemi,%72,2’sinde lökopeni ya da nötropeni mevcuttu. Bisitopenisi olan hastaların %41,9’unda anemi vetrombositopeni, %37,3’ünde lökopeni/nötropeni ve trombositopeni, %20,8’inde anemi ve lökopeni/nötropenibirlikte görüldü. Elli üç (%49,1) hastaya kemik iliği incelemesi yapıldı. En sık pansitopeni/bisitopeni nedenlerininenfeksiyon (%37,6), akut lösemi (%29,6) ve megaloblastik anemi (%17,5) olduğu görüldü.Sonuç: Pansitopeni/bisitopeni saptanan hastalarda klinik bulgular, tam kan sayımı ve periferik yayma bulgularıönemli ipuçları vermektedir. Malignensiden korkulsa da geri dönüşümlü benign nedenler etiyolojide çoğunluğuoluşturmaktadır

CLINICAL AND ETIOLOGICAL EVALUATION OF CHILDREN WITH PANCYTOPENIA / BICYTOPENIA

Introduction: Pancytopenia and bicytopenia are important clinical conditions that can be encountered frequently in childhood. Both benign or malignant conditions can cause pancytopenia and bicytopenia. In this study, it was aimed to evaluate clinical and laboratory findings in patients with pancytopenia and bicytopenia and to determine etiological causes. Material and Method: 108 newly diagnosed pancytopenia/bicytopenia patients aged between 3 months and 18 years who were followed up in the Department of Pediatric Hematology between January 2018 and January 2020 were included in the study. Laboratory findings including a detailed history, physical examination findings, peripheral smear and bone marrow examination were recorded. 80 İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi (Medical Journal of İzmir Hospital) Results: The female /male ratio was 56/52 in, and the average age was 6.2 years. Bicytopenia was present in 67 patients (62%) and pancytopenia in 41 patients (38%). The most common complaints were fever (63.9%), weakness (28.7%) and respiratory infection symptoms (20.3%). The most frequen tfindings on physical examination were pallor(50%), hepatomegaly (27.8%) and splenomegaly (26.8%). Thrombocytopenia was present in 86% whereas anemia and leukopenia or neutropenia were present 76.9% and 72.2%, respectively. Of the patients with bicytopenia, anemia and thrombocytopenia were present in 41.9%, leucopenia/neutropenia and thrombocytopenia were present in 37.3%, and anemia together with leukopenia/neutropenia was present in 20.8% of the patients. Bone marrow biopsy was performed in 51 patients (49.1%). The most common causes of pancytopenia/bicytopenia were infection (37.6%), acute leukemia (29.6%) and megaloblastic anemia (17.5%). Conclusion: Clinical findings, complete blood count and peripheral smear give valuable clues in patients with pancytopenia/bicytopenia. Although malignancy is the primary concern in these patients, benign conditions constitute the majority in etiology.

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