Allojenik Pediatrik Hematopoietik Kök Hücre Nakli Sonrasında Venöz Tromboembolizm: Bir Merkezin Deneyimi

Venous Thromboembolism after Allogeneic Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Study

FATİH MEHMET AZIK,Dilek GÜRLEK GÖKÇEBAY,Betül TAVİL,Pamir IŞIK,Bahattin TUNÇ,Duygu UÇKAN

Özet

Hematopoetik kök hücre nakli (HSCT) yapılan hastalarda venöz tromboembolizm (VTE) yüksek morbiditeye sahiptir. Bu çalışmanın amacı pediatrik allojenik HSCT alıcılarındaki VTE insidansını belirlemek ve pretransplant protrombotik risk faktörlerinin trombozdaki rolünü saptamaktır.Gereç ve Yöntemler:Nisan 2010-Kasım 2012 tarihleri arasında allojenik HSCT yapılan ve HSCT sonrası 100 gününü tamamlayan 92 hasta retrospektif olarak değerlendirildi. Kök hücre nakli öncesinde tüm hastalardan koagülasyon profili

Abstract

Venous thromboembolism (VTE) in children who undergo hematopoietic stem cell transplantation (HSCT) has high morbidity. The aim of this study is to assess the incidence of VTE in allogeneic pediatric HSCT recipients and the contribution of pretransplant prothrombotic risk factors to thrombosis. Materials and Methods:We retrospectively evaluated 92 patients between April 2010 and November 2012 undergoing allogeneic HSCT who had completed 100 days post-HSCT. Before HSCT, coagulation profiles; acquired and inherited prothrombotic risk factors including FV G1691A (factor V Leiden), prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C mutations; and serum homocysteine and lipoprotein (a), plasma antithrombin III, protein C, and protein S levels were obtained from all patients.Results:In the screening of thrombophilia, 8 patients (9%) were heterozygous for factor V Leiden, 5 (6%) were homozygous for MTHFR 677TT, 12 (14%) were homozygous for MTHFR 1298CC, and 2 (2%) were heterozygous for prothrombin G20210A mutation. We observed VTE in 5 patients (5.4%); a prothrombotic risk factor was found in 3 out of these 5 patients, while 4 out of 5 patients had central venous catheters. It was determined there was no significant relationship between VTE and inherited prothrombotic risk factors. Conclusion:VTE after HSCT seems to be a low-frequency event that may be due to low-dose, low-molecular-weight heparin prophylaxis, and the role of inherited prothrombotic risk factors cannot be entirely excluded without a prospective study