Evaluation of clinic and hematological profile of children with thrombocytosis

Year 2019, , 79 - 84, 21.03.2019

Melahat Melek Oguz Esma Altınel Açoğlu

https://doi.org/10.18663/tjcl.444674

Cited By: 2

Abstract

Aim: Thrombocytosis
is come across as an unexpected finding in children and usually appears as
reactive thrombocytosis. The objective of this study is to determine the
incidence rate of thrombocytosis in children, the etiologic factors, duration
until normalization of thrombocytosis and the correlation between
thrombocytosis and thrombocyte parameters and other variables.

Material and Methods: The
study included the children between 6 months and 18 years of age who were
admitted to Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and
Research Hospital and were diagnosed as thrombocytosis.

Results: The incidence of
thrombocytosis was found to be 10.8% among 107564 pediatric patients throughout
two years period. Sixty four point five percent of these patients were the
children between ages of 6 months and 2 years. Severe thrombocytosis developed
in 141(1.2%) patients. The most common acute thrombocytosis causes were,
infection in 80 patients (56.8%), anemia in 21 patients (14.9%), autoimmune
diseases in 14 patients (9.9%) respectively. The average normalization of acute
thrombocytosis was 40.2±34 days (3-210). No thromboembolic events were
observed. There was a significant negative correlation between the platelet
number and the MPV (p<0.05, r=-0.214). No correlation was found between
platelet numbers and PDW levels (p=0.95). Statistically significant correlation
was found between the number of platelet and the sedimentation rate (p<0.05,
r=0,233) while no correlation was found between CRP level and thrombocyte
number (p=0.15).

Conclusions: The study showed that
reactive thrombocytosis is a common finding which implies varying underlying
reasons. In our sample of patients primary thrombocytosis was never observed.
For this reason the differential diagnosis and treatment of thrombocytosis can
be evaluated by basic pediatric approach and hematology consultation is rarely
needed. Especially in acute thrombocytosis if there is no observable infection
or anemia the underlying causes can be the chronic inflammatory diseases.

Keywords

thrombocytosis, primary etiology, secondary etiology

Trombositoz saptanan çocuklarda klinik ve hematolojik profilin değerlendirilmesi

Abstract

Amaç: Trombositoz çocuklarda beklenmeyen bir bulgu olarak
karşımıza çıkmakta ve daha çok reaktif trombositoz görülmektedir.Bu çalışmanın amacı çocuklarda
trombositozun; sıklığını, nedenlerini, düzelme süresini, trombosit
parametreleri ve enfeksiyon belirteçleri ile korelasyonunu belirlemektir.

Gereç ve Yöntemler:Ekim 2016 ile Mayıs 2018 tarihleri
arasında Dr. Sami Ulus Kadın Doğum ve Çocuk Sağlığı ve Hastalıkları Eğitim ve
Araştırma Hastanesinde 6 ay 18 yaş arası trombositoz saptanan çocukların dahil
edildiği tanımlayıcı bir çalışmadır.

Bulgular: Toplam 107564 hastanın %10,8 (n=11643)’inde
trombositoz saptandı. Bu hastaların %64,5’i 6ay-2 yaş arası çocuklardan
oluşuyordu. Ciddi trombositozun 141(%1,2) hastada geliştiği görüldü.En sık
ciddi trombositoz nedenleri sırası ile 80 hastada (%56,8) enfeksiyonlar, 21
hastada anemi (%14,9), 14 (%9,9) hastada ise otoimmun hastalıklar idi. Ciddi
trombositozların ortalama düzelme süresi 40,2±34 gün (3-210) olarak hesaplandı.
Hastaların hiçbirinde tromboembolik komplikasyon görülmedi. Trombosit sayısı
ile ortalama trombosit hacmi arasında
istatistiksel olarak anlamlı negatif korelasyon olduğu görüldü (p<0,05,
r=-0,214). Trombosit dağılım genişliği düzeyi ile trombosit sayısı arasında
korelasyon görülmedi (p=0,95). CRP düzeyi ile trombosit sayısı arasında istatistiksel
olarak anlamlı korelasyon saptanmadı (p=0,15).Trombosit sayısı ile
sedimantasyon hızı arasında ise istatistiksel olarak anlamlı korelasyon bulundu
(p<0,05, r=0,233). 

Sonuç: Çalışmamızda reaktif trombositozun sık rastlanılan
bir bulgu olduğunu ve bu büyük örneklemde primer trombositozun hiç görülmediğini, sekonder trombositozda altta yatan birçok farklı nedenin olabileceğini saptadık. Dolayısı
ile trombositozun ayırıcı tanısı ve yaklaşımı pediatri uzmanı tarafından
yapılmalıdır ve hematoloji bölümü konsültasyonu nadiren gerekmektedir. Özellikle
ciddi trombositozlarda gösterebildiğimiz enfeksiyon veya anemi yoksa kronik
inflamatuar hastalıkların altta yatan neden olabileceği unutulmamalıdır.

Keywords

Trombositoz, primer etyoloji, sekonder etyoloji

References

• 1. Chiarello P, Magnolia M, Rubino M, Liguori S, Miniero R. Thrombocytosis in children. Minerva pediatrica 2011; 63: 507-13.
• 2. Harrison CN, Bareford D, Butt N et al. Guideline for investigation and management of adults and children presenting with a thrombocytosis. British journal of haematology 2010; 149: 352-75.
• 3. Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. British journal of haematology 2005; 129: 165-77.
• 4. Kucine N, Chastain KM, Mahler MB, Bussel JB. Primary thrombocytosis in children. Haematologica 2014; 99: 620-28.
• 5. Aladily TN, Mohammad RS, Al-Khader A, Awidi AS. Essential Thrombocythemia in a Two-year-old Child, Responsive to Hydroxyurea but Not Aspirin. Oman medical journal 2017; 32: 243.
• 6. Indolfi G, Catania P, Bartolini E et al. Incidence and clinical significance of reactive thrombocytosis in children aged 1 to 24 months, hospitalized for community-acquired infections. Platelets 2008; 19: 409-14.
• 7. Zheng S-Y, Xiao Q-Y, Xie X-H et al. Association between secondary thrombocytosis and viral respiratory tract infections in children. Scientific reports 2016; 6: 22964.
• 8. Matowicka-Karna J. Markers of inflammation, activation of blood platelets and coagulation disorders in inflammatory bowel diseases. Postepy higieny i medycyny doswiadczalnej (Online) 2016; 70: 305-12.
• 9. Nigrovic LE, Nigrovic PA, Harper MB, Chiang VW. Extreme thrombocytosis predicts Kawasaki disease in infants. Clinical pediatrics 2006; 45: 446-52.
• 10. Özdemir H, Çiftçi E, Tapısız A et al. Clinical and epidemiological characteristics of children with Kawasaki disease in Turkey. Journal of tropical pediatrics 2009; 56: 260-62.
• 11. Voudoukis E, Karmiris K, Koutroubakis IE. Multipotent role of platelets in inflammatory bowel diseases: a clinical approach. World Journal of Gastroenterology: WJG 2014; 20: 3180.
• 12. Lin C, Yang Y, Lee C, Huang C, Wang L, Chiang B. Thrombopoietin and interleukin-6 levels in Henoch-Schonlein purpura. Journal of Microbiology Immunology and Infection 2006; 39: 476.
• 13. Griesshammer M, Bangerter M, Sauer T, Wennauer R, Bergmann L, Heimpel H. Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count. Journal of internal medicine 1999; 245: 295-300.
• 14. Dihingia S, Deka K, Bhuyan D, Mondal SK. Life-threatening thrombocytosis following GCSF treatment in a case of clozapine-induced agranulocytosis. General hospital psychiatry 2012; 34: 320.
• 15. Yung KC, Zhang ZW, Yu WJ et al. Preliminary investigation about the expression of tubulin in platelets from patients with iron deficiency anemia and thrombocytosis. Hematology 2018; 23: 549-57.
• 16. Subramaniam N, Mundkur S, Kini P, Bhaskaranand N, Aroor S. Clinicohematological study of thrombocytosis in children. ISRN hematology 2014; 2014: 389257.
• 17. Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Postsplenectomy reactive thrombocytosis. Baylor University Medical Center Proceedings; 2009: Taylor & Francis.
• 18. Kiro K, Ganjoo P, Saigal D, Hansda U. Incidental thrombocytosis: Should it concern the anesthesiologist? Journal of anaesthesiology, clinical pharmacology 2014; 30: 281.
• 19. Mantadakis E, Tsalkidis A, Chatzimichael A. Thrombocytosis in childhood. Indian pediatrics 2008; 45: 669.
• 20. Vora A, Lilleyman J. Secondary thrombocytosis. Archives of disease in childhood 1993; 68: 88-90.
• 21. Chan KW, Kaikov Y, Wadsworth LD. Thrombocytosis in childhood: a survey of 94 patients. Pediatrics 1989; 84: 1064-67.
• 22. Sarangi R, Pradhan S, Dhanawat A, Patanayak R, Benia G. Thrombocytosis in children: Clinico-hematological profile from a single centre in Eastern India. Journal of laboratory physicians 2018; 10: 34.
• 23. Gokcek E, Kaydu A. Investigation of mean platelet volume and platelet count in the blood of patients with lumbago and sciatica. Anesthesia, essays and researches 2018; 12: 855.