İMMÜN (İDYOPATİK) TROMBOSİTOPENİK PURPURA TEDAVİSİNDE SPLENEKTOMİ

Cihan URAS, M. Süphan ERTÜRK, Zafer BAŞLAR, Teoman SOYSAL, Burhan FERHANOĞLU, Hakan YARDIMCI

Özet

İmmün trombositopenik purpura, dolaşantrombosit sayısında belirgin azalma, trombosityaşam süresinde kısalma ve kemik iliğindekimegakaryositlerde kompansatris artış ilekarakterize olan ve kanama diatezine yol açan birhastalıktır. Trombositlere karşı gelişen IgG yapısındaotoantikorlara bağlıdır. İdiopatik olabildiği gibi,çeşitli hastalıklarla birlikte de görülebilir. ITP' nıntedavisi hastanın yaşına, hastalığın ağırlığına veklinik seyrine bağlıdır. Splenektomi ITP' da seçkintedavi yöntemi olup, steroidlere cevapsız ya danükseden hastalarda tercih edilir.Bu retrospektif klinik çalışmada, 1980-1994 yıllarıarasında Cerrahpaşa Tıp Fakültesi Genel CerrahiAnabilim Dalı’nda ITP nedeni ile splenektomiuygulanan 63 hastaya ait kayıtlar gözden geçirilmiş vekonu güncel literatür eşliğinde irdelenmiştir.

Abstract

Background and Design.- Immune trombocytopenic purpura (ITP) is a condition causing hemorrhagic diathesis and characterized by marked reduction in the number of circulating platelets, shortened platelet life span and abundant megakaryocytes in the bone marrow. Pathogenesis of ITP is related to lgG autoantibodies against platelets. It may be idiopathic or due to other disorders e.g. SLE, lymphoproliferative diseases, some bacterial or viral infections or drugs. Treatment of IT P depends on the age of the patient, severity of the disease, duration of trombocytopenia and type of clinical course. Splenectomy is the most effective form of therapy and is indicated for patients who do not respond to steroids or relaps after initial remission. Results.- Of the 40 female and 23 male patients with ages ranging from 14 to 60 years, the majority were in 2nd and 3rd decades. Decision to proceed to splenectomy was given due to steroid unresponsiveness in 65%, relapse or steroid dependency in 25% and unacceptable toxicty of steroids in 10%. Accesory spleens were found in 17.4%. In 3 patients post-operative infections developed, one of whom died at one mounth in septic shock. Treatment-related mortality was 1 .6% and failure (platelet IOO x 1 0 9 /L) with follow up ranging 1 and 6 years. Conclusion.- In ITP, splenectomy is an effective treatment modality in patients who are unresponsive to or relapse after treatment with glucocorticoids or in whom they are contraindicated or treatment leads to major complications.