Handan CİPİL, Ayşe KARGILI, Hakan ŞENARAN, Ebru UZ, Benan KAASAPOĞLU, Özlem ALICI, Ali KOŞAR, Burak UZ

Thrombosis and thrombocytosis in a thousand rheumatologic cases

Bu çalışmanın amacı romatolojik hastalıklarda trombo-sitoz ve tromboz insidansının belirlenmesidir. 2001-2008 yılları arasında romatolojik hastalık tanısı ile izlenmiş 1000 vaka (771 kadın, 229 erkek) retrospektif olarak tarandı. Herbir hastalık için tromboz vetrom-bositoz insidansı belirlendi. Trombositoz (platelet sayısı >400 000/mm3) vakaların 89'unda (%8,9) mevcuttu. Pulmoner emboli ve derin venöz tromboz sırası ile 8 (%0,8)ve 14 (%1,4) vakada mevcuttu. Pulmoner embolisi olan hastaların 2'sinde trombositoz vardı. Trombositoz romatoid artrit, Sjögren sendromu, Sistemik lupus eritematozis, Behçet hastalığı ve sklerodermada daha sıktı. Tromboz ise Behçet hasta-lığında daha sıktı. Romatolojik hastalıklarda trombositoz ile tromboz arasında ilişki saptanmadı. Ciddi komplikasyonların gelişmesini önlemek için roma-tolojik hastalığı olan hastalar tromboz varlığı açısından değerlendirilmelidir.

Bin romatolojik vakada tromboz ve trombositoz

The aim of the study is to identify the incidence of thrombocytosis and thrombosis in patients with rheumatologic diseases. Thousand cases (771 female, 229 male) who had the diagnosis of any rheumatological disease and who were evaluated between 2001-2008 were included in this retrospective study. The incidence of thrombosis and thrombocytosis in each rheumatologic disease was investigated. Thrombocytosis (platelet >400 000/mm3) was found in 89 cases (8.9%). Pulmonary embolism and deep-vein thrombosis were found in 8 cases (0.8%) and 14 cases (1.4%) respectively. Thrombocytosis was identified in 2 of 8 patients with pulmonary embolism. Thrombocytosis was found to be relatively common in rheumatoid arthritis, Sjögren’s syndrome, Systemic lupus erythematosis, Behçet’s disease and scleroderma. Thrombosis was found to be relatively common in Behçet’s disease. Incidence of thrombosis in our study was found to be lower than the previous studies and thrombocytosis incidence was similar to the literature. We did not find and relation between thrombocytosis and thrombosis in rheumatologic diseases. The patients with rheumatologic diseases have to be evaluated for presence of thrombosis to prevent possible serious complications.

PDF

___

1. Barbui T, Finazzi G. When and how to treat essential thrombocythemia. N Engl J Med 2005;353: 85-6.
2. Greist A. The role of blood component removal in essential and reactive thrombocytosis. Ther Apher 2002;6: 36-44.
3. Schafer AI. Thrombocytosis and thrombocythemia. Blood Rev 2001;15: 159-66.
4. Baldwin JG, Sellers GA. Profound thrombocytosis in a patient with iron-lack anemia. South Med J 1989;82: 662-3.
5. Farr M, Scott DL, Constable TJ, Hawker RJ, Hawkins CF, Stuart J. Thrombocytosis of active rheumatoid disease. Ann Rheum Dis 1983;42: 545-9.
6. Ertenli I, Kiraz S, Ozturk MA, Haznedaroglu I, Celik I, Calguneri M. Pathologic thrombopoiesis of rheumatoid arthritis. Rheumatol Int 2003;23: 49-60.
7. Randi ML, Fabris F, Rossi C, Girolami A. Which tests are most useful in distinguishing between reactive thrombocytosis and the thrombocytosis of myeloproliferative disease? Clin Lab Haematol 1992;14: 267-8.
8. Ertenli I, Haznedaroglu IC, Kiraz S, Celik I, Calguneri M, Kirazhi S. Cytokines affecting megakaryocytopoiesis in rheumatoid arthritis with thrombocytosis. Rheumatol Int 1996;16: 5-8.
9. Dahlqvist SR, Nilsson TK, Norberg B. Thrombocytosis in active rheumatoid arthritis. Relation to other parameters of inflammatory activity and confounding effect of automated cell counting. Clin Rheumatol 1988;7: 335-41.
10. Ertenli I, Kiraz S, Arici M, Haznedaroglu IC, Calguneri M, Celik I, et al. P-selectin as a circulating molecular marker in rheumatoid arthritis with thrombocytosis. J Rheumatol 1998; 25: 1054-8.
11. Colli S, Maderna P, Tremoli E, Colombo F, Canesi B. Platelet function in rheumatoid arthritis. Scand J Rheumatol 1982;11: 139-43.
12. Seriolo B, Accardo S, Garnero A, Fasciolo D, Cutolo M. Anticardiolipin antibodies, free protein S levels and thrombosis: a survey in a selected population of rheumatoid arthritis patients. Rheumatology (Oxford) 1999;38: 675-8.
13. Straneva JE, van Besien KW, Derigs G, Hoffman R. Is interleukin 6 the physiological regulator of thrombopoiesis? Exp Hematol 1992;20: 47-50.
14. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46: 1019-1.
15. Frati Munari AC, Martin Alarcon JS, Martinez-Cairo S. Thrombocytosis in juvenile rheumatoid arthritis. Bol Med Hosp Infant Mex 1978;35: 1109-11.
16. Seriolo B, Fasciolo D, Sulli A, Cutolo M. Homocysteine and antiphospholipid antibodies in rheumatoid arthritis patients: relationships with thrombotic events. Clin Exp Rheumatol 2001;19: 561-4.
17. Ward MM, Pyun E,Studenski S. Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus. Arch Intern Med 1996;156: 1337-44.
18. Ziakas PD, Giannouli S, Zintzaras E, Tzioufas AG, Voulgarelis M. Lupus thrombocytopenia: clinical implications and prognostic significance. Ann Rheum Dis 2005;64: 1366-9.
19. Afeltra A, Vadacca M, Conti L, Galluzzo S, Mitterhofer AP, Ferri GM. Thrombosis in systemic lupus erythematosus: congenital and acquired risk factors. Arthritis Rheum 2005;53: 452-9.
20. Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med 1990;112: 682-98.
21. Vianna JL, Khamashta MA, Ordi-Ros J, Font J, Cervera R. Comparison of the primary and secondary antiphospholipid syndrome: a European Multicenter Study of 114 patients. Am J Med 1994;96: 3-9.
22. Unikiene D,Misiuniene N. Antiphospholipid syndrome in patients with systemic connective tissue diseases. Medicina (Kaunas) 2003;39: 454-4.
23. Aksu K, Turgan N, Oksel F, Keser G, Ozmen D, Kitapçioğlu G, et al. Hyperhomocysteinaemia in Behcet's disease. Rheumatology (Oxford) 2001;40: 687-90.