Terapötik aferez işlemlerinin değerlendirilmesi;retrospektif ve prospektif veri toplama çalışması
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Terapötik aferez çeşitli hastalıklarda primer veya yardımcı tedavi olarak kullanılmaktadır. Trakya Üniversitesi Sağlık-Araştırma ve Uygulama Hastanesi Terapötik Aferez Merkezi'nde Ocak 2007 ve Ekim 2012 tarihleri arasında yapılan terapötik aferez işlemleri geriye dönük ve ileriye yönelik olarak incelenmiştir. Her bir hastanın; yaş, cinsiyet, boy, kilo, klinik endikasyon uygulama öncesi ve sonrası lökosit, biyokimyasal parametreleri kaydedildi. Her işlem için şu parametreler incelendi: cihaz ve venöz yol tipi (santral/periferal), kan miktarı ve plazma türü, işlem süresi, verilen yedek sıvının tipi, tedavi yanıtı ve yan etkiler. Ocak 2007 ve Ekim 2012 tarihleri arasında 126 hastaya 753 işlem yapıldı (64 erkek ve 62 kadın, ortalama yaş aralığı 50,5 ± 18,3 yıl). Bu işlemlerin 628'i terapötik plazma değişimi, 79'u kaskad filtrasyonu ve 46`sı sitaferez (lökositaferez ve trombositaferez) oluşturdu. Terapötik aferez uygulanan hastalıkların başında hematolojik (%42,9) ve nörolojik hastalıklar (%25,4) yer aldı. En sık üç hastalık grubu: Trombotik trombositopenik purpura, Gullian-Barre Sendromu ve Multipl Miyelom idi. American Society for Apheresis kılavuzuna göre terapötik plazma değişiminin %76,7'si, kaskad filtrasyonunun %63,2'si ve sitaferez işlemlerinin %82,6'sı kategori I-II idi. Trombotik trombositopenik purpura hastalık grubunda terapötik plazma değişimi sonrası trombosit sayısı anlamlı bir şekilde yükseldi. Lökosit sayısı lökositaferez sonrası, trombosit sayısı ise trombositaferez sonrası istatiksel olarak anlamlı bir şekilde düştü. Çalışmamızda total terapötik aferez komplikasyon oranı %9,6 olarak bulundu. Komplikasyonların %3,9'u damar yolu ve cihaz, %5,7'si ise tedavi ile ilgili idi. En sık görülen yan etki; hipokalsemik semptomlardı. Akut myeloblastik lösemi tanılı bir hasta lökositaferez işlemi sırasında öldü. Sonuç olarak verilerimizin diğer yapılan çalışmalara benzer olduğu ve çeşitli hematolojik, nörolojik, metabolik ve diğer hastalıklarda uygulanabilen güvenli bir işlem olduğu düşünüldü.
Abstract
Therapuetic apheresis is used in certain diseases as a primary or supplementary treatment. In this study, therapuetic apheresis procedures performed between January 2007 and October 2012 in Trakya University Therapeutic Apheresis Unit was assessed retrospectively. Age, gender, height, weight, indications of the procedure, blood count and biochemistry panel before and after the procedure were recorded. Device and the access (central/peripheral), the volume and replacement modality as well as period of time, response to treatment and adverse effects were also recorded for every patient and procedure. A total of 753 procedures were performed for 126 patients from January 2007 to October 2012 (64 male and 62 female, median age 50.5+_18.3 years). Of these 753 procedures, 628 were therapeutic plasma exchange, 79 were cascade filtration, 46 were cytoapheresis (leucocytoapheresis and thrombocytoapheresis). Indications for therapuetic apheresis were majorly hematologic and neurologic. The most frequent indications for therapuetic apheresis were thrombotic thrombocytopenic purpura, Gullian-Barre syndrome and Multiple myeloma. The categories I and II indications for therapuetic apheresis according to American Society for Apheresis were observed in 76,2% of therapeutic plasma exchange, 63,2% of cascade filtration and 82,6% of cytoapheresis procedures. In 9,6% of the procedures, complications related with access and treatment itself were observed. The most frequent adverse effect was symptoms related with hypocalcemia. Only one patient with acute myeloblastic leukemia has died during leucocytoapheresis. In conclusion, our data are similar to other studies, and various hematological, neurological, metabolic, and orher diseases were thought to be a safe procedure that can be applied.
Abstract
Therapuetic apheresis is used in certain diseases as a primary or supplementary treatment. In this study, therapuetic apheresis procedures performed between January 2007 and October 2012 in Trakya University Therapeutic Apheresis Unit was assessed retrospectively. Age, gender, height, weight, indications of the procedure, blood count and biochemistry panel before and after the procedure were recorded. Device and the access (central/peripheral), the volume and replacement modality as well as period of time, response to treatment and adverse effects were also recorded for every patient and procedure. A total of 753 procedures were performed for 126 patients from January 2007 to October 2012 (64 male and 62 female, median age 50.5+_18.3 years). Of these 753 procedures, 628 were therapeutic plasma exchange, 79 were cascade filtration, 46 were cytoapheresis (leucocytoapheresis and thrombocytoapheresis). Indications for therapuetic apheresis were majorly hematologic and neurologic. The most frequent indications for therapuetic apheresis were thrombotic thrombocytopenic purpura, Gullian-Barre syndrome and Multiple myeloma. The categories I and II indications for therapuetic apheresis according to American Society for Apheresis were observed in 76,2% of therapeutic plasma exchange, 63,2% of cascade filtration and 82,6% of cytoapheresis procedures. In 9,6% of the procedures, complications related with access and treatment itself were observed. The most frequent adverse effect was symptoms related with hypocalcemia. Only one patient with acute myeloblastic leukemia has died during leucocytoapheresis. In conclusion, our data are similar to other studies, and various hematological, neurological, metabolic, and orher diseases were thought to be a safe procedure that can be applied.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Terapötik Plazma Değişimi, Komplikasyon, Terapötik Aferez, Sitaferez, Therapeutic Plasma Exchange, Complication, Therapeutic Apheresis, Cytoapheresis
