Çocukta kronik immun trombositopenik purpura ( 63 hastada tedavi sonuçları )

Özet

1977-93 yılları arasında -Kliniğimizde izlenen 63 kronik immun trombositopenik purpuralı (ITP) hasta retrospektif olarak değerlendirildi. Hastaların 45'inde (%71,42) sadece deri ve mukoza kanamaları varken geri kalanlarda ayrıca epistaksis, dişeti kanaması ve genitoüriner sistem kanamaları eşlik ediyordu. Steroid tedavisi 43 hastada oral steroid, 77 hastada yüksek doz metil prednizolon (YDMP) şeklinde yapıldı. Oral steroid uygulanan hastaların 6'sında (%14), YDMP uygulanan 77 hastanın sadece birinde (%5,3) kalıcı yanıt elde edildi. 16 hastada intravenöz immunglobulin (IVIC) uygulandı ve hiçbirinde kalıcı yanıt elde edilmedi. 8 hastaya splenektomi uygulandı, 4'ünde kalıcı yanıt elde edildi. Hiçbir hastada spontan remisyon gözlenmedi. Kanamalarla veya santral sinir sistemi kanaması ile kaybedilen hasta olmadı. Oral steroid, YDMP ve IVIG'in kalıcı ve geçici remisyon yönünden birbirlerine üstünlükleri olmadığı, splenektominin kalıcı remisyon açısından en etkin tedavi şekli olduğu sonucuna varıldı.

Abstract

Chronic Immune Thrombocytopenic Purpura in Children Sixty-three chronic ITP. cases followedin our department between 1977-93 were evaluated retrospectively. Skin and mucous membrane bleedings were in 45(71.42%) of patients and the rest had presented with epistaxes, gum and genitourinary bleeding. Steroid treatment was given orally 1-2 mg/kg/day in 43 patients and as H DM P in 17. Complete sustained remission was obtanied in 6(14%) of the oral steroid and 1(5.3%) of HDMP patients. IVIC was given to 16 patients but hone achieved sustained remission. Eight patients were splenectomized and 4 had complete remission eventually. HDMP and IVIC were superior to oral steroids with respect to transient response. There were no spontaneous remissions and hone of the patients were lost due to hemorrhages or CNS bleeding. IVIG and HDMP were more effective to raise platelet counts in a short time, whereas oral steroids were more effective in obtaining sustained remission. Early initiation of steroids were observed to be a better predictor to achive sustained remission. Splenectomy should be performed in patients who are unresponsive to other treatment schemes have higher risk of bleeding. Finally, we conclude that, in respect to transient and sustained remission; oral steroid, YDMP and IVIC has no superiority to each other and splenectomy is the best treatment whe sustained remission is considered.