Akut immun trombositopenik purpura tanılı çocuklarda koagulasyon parametreleri

Immune thrombocytopenic purpura (ITP) is one of the most common causes of hemorrhagic diathesis during childhood. In this study, we investigated whether there is a change in the coagulation parameters and the effects of different treatment regimens on these parameters in children with acute ITP. Twenty one acute ITP patients were enrolled in the study. Patients were treated randomly with either intravenous immune globulin (IVIG) or intravenous pulsemethylprednisolone (PMP). Bleeding time (BT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, von Willebrand factor: ristocetin cofactor activity (vWF:RCoF) were tested at diagnosis. Protein C (PC), freeprotein S (f-PS), antithrombin (AT), D-dimer (DD), prothrombin fragment 1+2 (PF 1+2) and lupus anticoagulant (LA) were measured in the patients at diagnosis and after the treatment. Adequate platelet levels were obtained more rapidly in patients treated with IVIG than with PMP. At diagnosis, while AT and PF 1+2 levels were found significantly higher (p=0.0001) in the patients, DD level was significantly lower (p=0.0001). Nine patients (41 %) had LA positivity at diagnosis. After treatment, levels of PC, f-PS and AT increased significantly in PMP group when compared to IVIG group (p=0.004, 0.001, 0.017 respectively). These data show that there are some reactive changes in coagulation and fibrinolytic systems in addition to thrombocytopenia in acute ITP. Different therapy modalities may affect these parameters differently.