Emel KOÇER, Aytekin ALÇELİK, Gülşen KOCAMAN, Abdulkadir KOÇER

Akut stres reaksiyonu ile ilişkili olarak intihar girişiminde bulunan hastalarda lökosit ve trombosit aktiviteleri üzerine bir çalışma

Amaç: Akut stres reaksiyonu (ASR) sıklıkla depresyonla birlikte görülür ve stresle ilişkili hormonlar trombosit birikimiyle ilişkili arteriyel trombozda önemli rol oynarlar. Bilgimize göre ASR ile ilişkili bir intihar girişimi sonrasında lökosit ve trombosit sayımını değerlendiren çalışma yoktur. Yöntem: Bu çalışmada kan lökosit, trombosit ve ortalama trombosit hacim (MPV) düzeyleri incelendi. İlave olarak, bu parametreleri etkileyen etmenler değerlendirildi. Acile başvuran ve intihar girişimi sonrasında aynı psikiyatrist tarafından değerlendirilen hastalara ait veriler toplandı. Aynı bölgede yaşayan sağlıklı örneklem grubu kontrol grubu olarak kabul edildi. Vaka-kontrol çalışması olarak dizayn edilen bu çalışmada 30 intihar girişimi vakası ve yaş ve cinsiyet olarak uygun 33 kontrol vakası analize tabi tutuldu. Bulgular: İntiharla ilişkili ASR tanısı olan 30 kişinin kontrollerle karşılaştırılmasında kan sonuçları artmış lökosit düzeyi saptanırken trombosit sayısı ve MPV düzeyleri benzer bulundu. Takipte, trombosit düzeyi hasta grubunda daha düşük düzeylerde bulundu (p=0.001) ve bu düşüklük intihar amaçlı antidepresan kullanımı ile ilişkiliydi (p=0.003). Sonuç: ASR sonrasında trombosit sayısı veya MPV düzeyi artmadı, fakat lökosit sayısında artış gözlemlendi. İlaveten, çalışmamız antidepresan ilaçlarla ilişkili anti-trombosit etkinin varlığını da desteklemekteydi.

Anahtar Kelimeler:

akut stres reaksiyonu, intihar, trombosit, lökosit, ilaçlar, anti-depresan, analjezik

A study of leukocyte and platelet activity in patients with suicide attempt related to acute stres reaction

Aim: Acute stress reaction (ASR) is often seen with depression, and stress-related hormones may play an important role in acute arterial thrombosis by increasing platelet aggregation. To the best of our knowledge, no study has examined leukocyte and platelet counts following a suicide attempt with ASR. Method: The present study examined blood leukocyte, platelet and mean platelet volume (MPV) levels. In addition, we examined the factors affecting these parameters. Data for patients who were admitted to the emergency room and evaluated by same psychiatrist after a suicide attempt were obtained from the health registries. Controls were selected from all residents living in the same area. Using a case-control design, we examined 30 suicide cases and 33 controls matched for gender and age. Results: The 30 subjects diagnosed with ASR related suicide showed increased white blood cell counts but similar platelet counts and mean platelet volume compared with controls. At follow-up, the platelet count was lower in patients than in controls (p= 0.001), which was related to suicide attempts by using anti-depressants (p= 0.003). Conclusion: ASR did not increase platelet count or MPV, but we found an increase in leukocyte counts following ASR. Additionally, our study supported the antiplatelet effect of antidepressant medications.

Keywords:

acute stress reaction, suicide, platelet, leucocyte, drugs, antidepressant, analgesic,

PDF

___

World Health Organization. The ICD-10 classification of mental and behavioral disorders: diagnostic criteria for research. Geneva: World Health Organization, Division of Mental Health, 1993.
Okulate GT. Suicide attempts in a Nigerian military setting. East Afr Med J. 2001;78:493-6.
Kim CK, McGorray SP, Bartholomew BA, Marsh M, Dicken T, Wassertheil-Smoller S, Curb JD, Oberman A, Hsia J, Gardin J, Wong ND, Barton B, McMahon RP, Sheps DS. Depressive symptoms and heart rate variability in postmenopausal women. Arch Intern Med. 2005;165:1239-44.
Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sİrensen HT, Lash TL. Acute stress reaction and completed suicide. Int J Epidemiol. 2010;39:1478-84.
Maes M, Van Bockstaele DR, Gastel A, Song C, Schotte C, Neels H, DeMeester I, Scharpe S, Janca A. The effects of psychological stress on leukocyte subset distribution in humans: evidence of immune activation. Neuropsychobiology. 1999;39:1-9.
Ots I, Murumagi A ,Horak P. Haematological health state indices of reproducing Great Tits: methodology and sources of natural variation. Functional Ecology. 1998;12:700-7.
Davis AK, Maney DL, Maerz JC. The use of leukocyte profiles to measure stress in vertebrates: a review for ecologists. Funct. Ecol. 2008;22:760-72.
Williams L. Depression and Stroke: Cause or Consequence ? Semin Neurol. 2005;25:396-409.
Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, Finkel MS, Krishnan KR, Gaffney M, Harrison W, Califf RM, O’Connor CM. Sertraline AntiDepressant Heart Attack Randomized Trial Study Group. Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation. 2003;108:939-44. Ataoglu A, Canan F. Mean platelet volume in patients with major depression: effect of escitalopram treatment. J Clin Psychopharmacol. 2009;29:368-71.
Pozzi AO, Bernardo E, Coronado MT, Punchard MA, González P, Fantidis P. Acute arterial thrombosis in the absence of inflammation: the stress-related anti-inflammatory hormone ACTH participates in platelet-mediated thrombosis. Atherosclerosis. 2009;204:79-84. Yetkin E. Mean platelet volume not so far from being a routine diagnostic and prognostic measurement. Thromb Haemost. 2008;100:3-4.
Muscari A, De Pascalis S, Cenni A, Ludovico C, Castaldini N, Antonelli S, Bianchi G, Magalotti D, Zoli M. Determinants of mean platelet volume (MPV) in an elderly population: relevance of body fat, blood glucose and ischaemic electrocardiographic changes. Thromb Haemost. 2008;99:1079-84.
Askın R, Herken H. Selektif serotonin geri alım inhibitörleri ve beklenmeyen yan Etkileri. Klinik Psikofarmakoloji Bülteni. 1998;8:249-50.
Hourani S, Cusack N. Pharmacologic receptors on blood platelets. Pharmacol Rev. 1991;43:243-98.
Declerck F. The role of serotonin in thrombogenesis. Clinical Physiology and Biochemistry. 1991;8:40-9.