Yıl: 2011 Cilt: 28 Sayı: 3 Sayfa Aralığı: 198 - 205 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Management of autoimmune hemolytic anemia in children and adolescents: A single center experience

Öz:
Amaç: Bu makalede otoimmün hemolitik anemi tedavisinin tartışılması amaçlanmıştır. Yöntemler ve Gereçler: Üçüncü basamak bir hematoloji merkezinde 10 yıl içinde tanı alan tüm otoimmün hemolitik anemi olgularının (OİHA) (n=19) hastane kayıtları geriye dönük olarak incelenmiştir. Tanı sırasında ortanca yaş 5 (4 ay-17 yaş) tir. On üç hastada primer (idyopatik) OİHA, 3 hastada primer Evans Sendromu (ES), 2 hastada otoimmün lenfoproliferatif sendrom (OLPS) +ES, ve 1 has- tada Wiskott-Aldrich sendromu (WAS) +OIHA saptanmıştır. On üç primer OİHA’li hastadan dokuzu 4-8 haftalık prednizolon tedavisine cevap verirken ve nüks etmezken, üç hasta daha uzun süreli pred- nizolon gerektirdi. Hastalardan biri prednizolona oldukça dirençliydi ve siklosporin A (CsA) ilavesiyle hemoliz kontrol altına alınabildi. Tüm primer OİHA’li hastalar ortalama 3 yıllık (4 ay-10 yıl) takipte remisyondaydı. Primer ES’lu hastaların ikisinde OİHA, OLPS’li hastalara benzer şekilde nükslerle seyretti. Primer ES’li hastaların birine splenektomi yapıldı ve halen remisyondadır. OLPS’li hastaların biri prednizolona ilave olarak dirençli OİHA nedeniyle mikofenolat mofetil de gerektirdi. WAS lı hasta dirençli OİHA atağı sırasında septisemi ile kaybedildi. Sonuç: Çocukluk çağında primer OİHA genellikle kortikosteroide iyi cevap veren akut bir seyir gösterirken, primer veya sekonder ES nükslerle giden kronik bir seyir gösterir ve tedavide kortikosteroidlere ilave olarak diğer immunosupresif ajanlar da gerekebilir. Altta yatan immün yetersizlik olduğunda splenektominin komplikasyonları göz ardı edilmemelidir. WAS’da OİHA kayda değer mor- bidite ve mortalite nedenidir.
Anahtar Kelime:

Konular: Hematoloji

Çocuk ve ergenlerde otoimmün hemolitik anemi tedavisi: Tek merkez deneyimi

Öz:
Objective: To present and discuss the treatment of autoimmune hemolytic anemia (AIHA). Materials and Methods: The medical records of all patients (n=19) diagnosed in a tertiary hematol- ogy center between 1999 and 2010 were retrospectively reviewed. Results: Median age at diagnosis of AIHA was 5 years (range: 4 months-17 years). In all, 13 patients had primary (idiopathic) AIHA, whereas 2 had primary Evans Syndrome (ES), 2 had autoimmune lymphop- roliferative syndrome (ALPS)+ES, and 1 had Wiskott-Aldrich syndrome (WAS)+AIHA. Among the 13 primary idiopathic AIHA patients, 9 recovered following a 4-8-week course of prednisolone treatment without relapses, whereas 3 patients required a longer course of prednisolone. One AIHA patient that was very resistant to prednisolone recovered after cyclosporine A was added to the treatment. All patients with primary idiopathic AIHA were in remission for a median of 3 years (range: 4 months-10 years) at the time this manuscript was written. Among the patients with primary ES, 2 had relapses similar to the ALPS patients. Splenectomy was performed in 1 primary ES patient, who at the time this report was written was also in remission. One ALPS patient required the addition of mycophenolate mofetil due to prednisolone resistance. The WAS patient was treatment resistant and died due to septicemia. Conclusions: Primary AIHA in pediatric patients generally has an acute onset and good response to corticosteroids. Primary or secondary ES has a chronic or relapsing course, and treatment may require other immunosuppressive agents in addition to corticosteroids. Complications of splenectomy must not be underestimated in patients with underlying immunodeficiency. AIHA often causes considerable morbidity and mortality in WAS.
Anahtar Kelime:

Konular: Hematoloji
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA Sarper N, KILIÇ ÇAKI S, ZENGİN E, AYLAN GELEN S (2011). Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. , 198 - 205.
Chicago Sarper Nazan,KILIÇ ÇAKI Suar,ZENGİN Emine,AYLAN GELEN SEMA Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. (2011): 198 - 205.
MLA Sarper Nazan,KILIÇ ÇAKI Suar,ZENGİN Emine,AYLAN GELEN SEMA Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. , 2011, ss.198 - 205.
AMA Sarper N,KILIÇ ÇAKI S,ZENGİN E,AYLAN GELEN S Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. . 2011; 198 - 205.
Vancouver Sarper N,KILIÇ ÇAKI S,ZENGİN E,AYLAN GELEN S Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. . 2011; 198 - 205.
IEEE Sarper N,KILIÇ ÇAKI S,ZENGİN E,AYLAN GELEN S "Management of autoimmune hemolytic anemia in children and adolescents: A single center experience." , ss.198 - 205, 2011.
ISNAD Sarper, Nazan vd. "Management of autoimmune hemolytic anemia in children and adolescents: A single center experience". (2011), 198-205.
APA Sarper N, KILIÇ ÇAKI S, ZENGİN E, AYLAN GELEN S (2011). Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. Turkish Journal of Hematology, 28(3), 198 - 205.
Chicago Sarper Nazan,KILIÇ ÇAKI Suar,ZENGİN Emine,AYLAN GELEN SEMA Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. Turkish Journal of Hematology 28, no.3 (2011): 198 - 205.
MLA Sarper Nazan,KILIÇ ÇAKI Suar,ZENGİN Emine,AYLAN GELEN SEMA Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. Turkish Journal of Hematology, vol.28, no.3, 2011, ss.198 - 205.
AMA Sarper N,KILIÇ ÇAKI S,ZENGİN E,AYLAN GELEN S Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. Turkish Journal of Hematology. 2011; 28(3): 198 - 205.
Vancouver Sarper N,KILIÇ ÇAKI S,ZENGİN E,AYLAN GELEN S Management of autoimmune hemolytic anemia in children and adolescents: A single center experience. Turkish Journal of Hematology. 2011; 28(3): 198 - 205.
IEEE Sarper N,KILIÇ ÇAKI S,ZENGİN E,AYLAN GELEN S "Management of autoimmune hemolytic anemia in children and adolescents: A single center experience." Turkish Journal of Hematology, 28, ss.198 - 205, 2011.
ISNAD Sarper, Nazan vd. "Management of autoimmune hemolytic anemia in children and adolescents: A single center experience". Turkish Journal of Hematology 28/3 (2011), 198-205.