Trombositoz saptanan çocuklarda klinik ve hematolojik profilin değerlendirilmesi

Amaç: Trombositoz çocuklarda beklenmeyen bir bulgu olarak karşımıza çıkmakta ve daha çok reaktif trombositoz görülmektedir.Bu çalışmanın amacı çocuklarda trombositozun; sıklığını, nedenlerini, düzelme süresini, trombosit parametreleri ve enfeksiyon belirteçleri ile korelasyonunu belirlemektir.Gereç ve Yöntemler:Ekim 2016 ile Mayıs 2018 tarihleri arasında Dr. Sami Ulus Kadın Doğum ve Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesinde 6 ay 18 yaş arası trombositoz saptanan çocukların dahil edildiği tanımlayıcı bir çalışmadır.Bulgular: Toplam 107564 hastanın %10,8 (n=11643)’inde trombositoz saptandı. Bu hastaların %64,5’i 6ay-2 yaş arası çocuklardan oluşuyordu. Ciddi trombositozun 141(%1,2) hastada geliştiği görüldü.En sık ciddi trombositoz nedenleri sırası ile 80 hastada (%56,8) enfeksiyonlar, 21 hastada anemi (%14,9), 14 (%9,9) hastada ise otoimmun hastalıklar idi. Ciddi trombositozların ortalama düzelme süresi 40,2±34 gün (3-210) olarak hesaplandı. Hastaların hiçbirinde tromboembolik komplikasyon görülmedi. Trombosit sayısı ile ortalama trombosit hacmi arasında istatistiksel olarak anlamlı negatif korelasyon olduğu görüldü (p<0,05, r=-0,214). Trombosit dağılım genişliği düzeyi ile trombosit sayısı arasında korelasyon görülmedi (p=0,95). CRP düzeyi ile trombosit sayısı arasında istatistiksel olarak anlamlı korelasyon saptanmadı (p=0,15).Trombosit sayısı ile sedimantasyon hızı arasında ise istatistiksel olarak anlamlı korelasyon bulundu (p<0,05, r=0,233). Sonuç: Çalışmamızda reaktif trombositozun sık rastlanılan bir bulgu olduğunu ve bu büyük örneklemde primer trombositozun hiç görülmediğini, sekonder trombositozda altta yatan birçok farklı nedenin olabileceğini saptadık. Dolayısı ile trombositozun ayırıcı tanısı ve yaklaşımı pediatri uzmanı tarafından yapılmalıdır ve hematoloji bölümü konsültasyonu nadiren gerekmektedir. Özellikle ciddi trombositozlarda gösterebildiğimiz enfeksiyon veya anemi yoksa kronik inflamatuar hastalıkların altta yatan neden olabileceği unutulmamalıdır.

Anahtar Kelimeler:

Trombositoz, primer etyoloji, sekonder etyoloji

Evaluation of clinic and hematological profile of children with thrombocytosis

Aim: Thrombocytosis is come across as an unexpected finding in children and usually appears as reactive thrombocytosis. The objective of this study is to determine the incidence rate of thrombocytosis in children, the etiologic factors, duration until normalization of thrombocytosis and the correlation between thrombocytosis and thrombocyte parameters and other variables.Material and Methods: The study included the children between 6 months and 18 years of age who were admitted to Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital and were diagnosed as thrombocytosis. Results: The incidence of thrombocytosis was found to be 10.8% among 107564 pediatric patients throughout two years period. Sixty four point five percent of these patients were the children between ages of 6 months and 2 years. Severe thrombocytosis developed in 141(1.2%) patients. The most common acute thrombocytosis causes were, infection in 80 patients (56.8%), anemia in 21 patients (14.9%), autoimmune diseases in 14 patients (9.9%) respectively. The average normalization of acute thrombocytosis was 40.2±34 days (3-210). No thromboembolic events were observed. There was a significant negative correlation between the platelet number and the MPV (p<0.05, r=-0.214). No correlation was found between platelet numbers and PDW levels (p=0.95). Statistically significant correlation was found between the number of platelet and the sedimentation rate (p<0.05, r=0,233) while no correlation was found between CRP level and thrombocyte number (p=0.15). Conclusions: The study showed that reactive thrombocytosis is a common finding which implies varying underlying reasons. In our sample of patients primary thrombocytosis was never observed. For this reason the differential diagnosis and treatment of thrombocytosis can be evaluated by basic pediatric approach and hematology consultation is rarely needed. Especially in acute thrombocytosis if there is no observable infection or anemia the underlying causes can be the chronic inflammatory diseases.

Keywords:

thrombocytosis, primary etiology, secondary etiology,

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