Kronik böbrek yetmezliği olan pediatrik hastalarda trombosit fonksiyonlarının değerlendirilmesi

Year 2019, Volume: 17 Issue: 2, 220 - 231, 02.08.2019

Funda Tayfun Küpesiz , Canan Vergin Mustafa Bak

Abstract

GİRİŞ
ve AMAÇ: Kronik böbrek yetmezliği olan hastalarda üreminin ciddiyeti ve
süresine bağlı olarak kanamaya yatkınlık görülebilir. Günümüzde etkin diyaliz
işlemleri ile trombosit fonksiyon bozukluğu yapan üremik toksinlerin
uzaklaştırılması kanama bozukluklarının kısmen düzeltilmesi sağlamıştır. Bu
çalışmada kronik böbrek yetmezliği hastalarında kanama bulgularını, trombosit
fonksiyon bozukluğunun varlığını ve bunu etkileyen faktörleri değerlendirmeyi
amaçladık. 

YÖNTEM ve GEREÇLER: Dr. Behçet Uz Çocuk Hastalıkları ve Çocuk Cerrahisi Eğitim
ve Araştırma Hastanesi Nefroloji Kliniğinde KBY olarak takip edilen hastalar
prospektif olarak değerlendirildi. Çalışma grubu 57 hasta ve 31 sağlıklı
kontrol grubundan oluştu. Trombosit yüzeyi fibrinojen (GP IIb-IIa) ve von
Willebrand Faktör (vWF) reseptörleri (GP Ib-IX) akım sitometri ile ölçüldü. İn
vitro kanama zamanı ise trombosit fonksiyon ölçüm (PFA 100) yöntemi ile
ölçüldü.

BULGULAR: PFA 100 analizi sonucunda; hemodiyaliz hastalarında ortanca
kollojen/epinefrin, kollojen/ADP kapanma zamanı periton diyalizi ve kontrol
grubu hastalarına göre istatistiksel olarak anlamlı yüksek bulundu (p=0,000,
p=0,000); ancak bu değerler hemodiyaliz işleminden sonra normal düzeylere döndü
(p= 0,018, p= 0,028). Periton diyalizi hastalarının in vitro kanama zamanı
normal aralıktaydı. Periton diyalizi in vitro kanama zamanını hemodiyalize göre
daha iyi düzeltiyordu. Akım sitometri ile yapılan analizlerde; diyaliz yapılan
hastalardaki GP Ib (CD42b mAb) düzeylerinin kontrol grubuna göre anlamlı olarak
yüksek olduğu görüldü (p= 0,037). Hemodiyaliz yapılan hastalarda ise fibrinojen
reseptör (GPIIb) düzeyi hemodiyaliz sonrası anlamlı düzeyde azalıyordu
(p=0,018). 

TARTIŞMA ve SONUÇ: Üremik hastalarda trombosit fonksiyon bozukluğuna bağlı
primer hemostazı değerlendirebilmek için PFA 100 yöntemi akım sitometriye göre
daha kolay uygulanabilen ve ulaşılabilen bir test olarak kanama riski olan
hastaların ilk değerlendirmesinde yol gösterici olabilir. 

Keywords

kronik böbrek yetmezliği, diyaliz, trombosit fonksiyonu

Evaluation of platelet functions in pediatric patients with chronic renal failure

Abstract

INTRODUCTION:
Patients with chronic renal failure may tend to bleed in relation to the
severity and duration of uremia. Currently, effective dialysis procedures and
the removal of uremic toxins that cause platelet dysfunction partially
alleviate bleeding disorders. In this study, our aim was to evaluate bleeding,
platelet dysfunction, and factors that were effective on platelet dysfunction
in patients with chronic renal failure.

METHODS: This study was a prospective evaluation of patients who were followed
by the Nephrology Clinic of Behçet Uz Children's Diseases and Pediatric Surgery
Training and Research Hospital with a diagnosis of chronic renal failure. The
study group consisted of 57 patients and 31 healthy controls. Platelet surface
fibrinogen (GP IIb-IIa) and von Willebrand Factor (vWF) receptors (GP Ib-IX)
were measured by flow cytometry. In vitro bleeding time was measured by the
platelet function analyzer method (PFA 100).

RESULTS: PFA 100 analysis showed that median closure time was significantly
higher among hemodialysis patients in terms of collagen/epinephrine,
collagen/ADP comparisons (p = 0.000, p = 0.000); however, these values returned
to normal after hemodialysis (p = 0.018, p = 0.028). The in vitro bleeding time
of patients undergoing peritoneal dialysis was found to be in the normal range.
The in vitro bleeding time improvements were better in peritoneal dialysis
compared to hemodialysis. Analysis with flow cytometry showed that; GP Ib
(CD42b mAb) levels in dialysis patients were significantly higher than control
group and predialysis patients (p = 0.037). The fibrinogen receptor (GPIIb) level
decreased significantly in hemodialysis patients,after hemodialysis (p =
0.018).

DISCUSSION AND CONCLUSION: The PFA 100 method, which is easier than the flow
cytometry method for the evaluation of primary hemostasis due to platelet
dysfunction in uremic patients, may prove to be an ideal method for the general
evaluation of primary hemostasis in the event of bleeding in uremic patients.

Keywords

chronic renal failure, platelet function

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