Bir üniversite hastanesi erişkin acil servisine başvuran pansitopenili hastaların etiyolojik, klinik ve hematolojik karakteristikleri
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Tarih
2023
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş
Pansitopeni, üç periferik kan hücresi serisinde azalma ile karakterize hematolojik bir bozukluktur ve klinik pratikte sık izlenmektedir. Pansitopeni, ilaca bağlı kemik iliği hipoplazisinden ölümcül kemik iliği yetmezliklerine ve lösemilere kadar uzanan birçok ciddi ve hayatı tehdit eden hastalığın bulgusu olarak ortaya çıkabilir. Hematoloji ve patoloji kliniklerine başvuran pansitopeni hastalarının özellikleri daha önce değerlendirilmiştir ancak acil servise başvuran pansitopeni hastaları daha önce değerlendirilmemiştir. Bununla birlikte, acil servisler sıklıkla pansitopeni ile başvuran hastalar için ilk tanı noktası olarak hizmet vermektedir. Çalışmamızın amacı, üçüncü basamak bir hastanenin acil servisine başvuran pansitopeni hastalarının etiyolojik, klinik ve hematolojik özelliklerini değerlendirmektir.
Gereç ve yöntem
Çalışmaya acil servise pansitopeni ile başvuran 541 hasta retrospektif olarak dahil edildi. Yaş, cinsiyet, eşlik eden hastalık varlığı ve laboratuvar verileri hasta dosyalarından elde edildi. Başvuru semptom ve bulguları, pansitopeni etiyolojisi ve pansitopeni ile ilişkili ilaç öyküsü kaydedildi. Hastaların acil servis sonlanımı servis yatış, taburculuk, yoğun bakım ünitesi yatışı ve exitus olarak değerlendirildi. Hastane içi mortalite oranları değerlendirildi, ilk 7 gün içerisinde kaybedilen olgular erken mortalite şeklinde sınıflandırıldı. Hastaların tanımlayıcı ve klinik özelliklerinin hastane içi erken mortalite ve cinsiyete göre gruplandırılarak karşılaştırılması planlandı. “p” değeri 0.05'in altında olan analizler anlamlı kabul edildi.
Bulgular
Hastaların yaş ortalaması 63,7 ± 16,0 yıl (20-96 yıl) idi. Erkek/kadın oranı 1,2/1 idi. Hastaların %74,5'inde anemi ile ilişkili semptomlar (halsizlik, çarpıntı, solukluk, baş dönmesi), %36,2'sinde nötropeni (ateş) ile ilişkili ve %19'unda trombositopeni ile ilişkili semptom ve bulgular izlendi. Pansitopeninin en yaygın etiyolojileri sırasıyla hematolojik malignite (%34,9), ilaç hipersensitivitesi (%32,0), enfeksiyon (%14,4), megaloblastik anemi (%8,9), non-malign hematolojik hastalık (%3,7), hipersplenizm (%1,8) ve aplastik anemi (%1,1) ve diğer nedenler (%11,8) idi. Hastaların acil sonlanımı %71,1 ’inde servis yatışı, %15,1 ’inde taburcu, %11,4’ünde YBÜ yatışı şeklindeydi. İlk 7 günlük hastane erken mortalite oranı %4,5 idi. İlk 7 gün içerisinde kaybedilen ve sağ kalan hastalar arasında demografik özellikler, semptom ve bulgular, laboratuvar sonuçları ve acil servis sonlanımı açısından farklılık yoktu. Enfeksiyona bağlı pansitopeni sıklığı ölen hastalarda daha fazlaydı (p<0.001). Erkek hastaların yaş ortalaması kadınlardan yüksekti (p<0.001). Hematolojik malignitelerin (lenfoma) sıklığı erkeklerde kadınlara göre anlamlı derecede yüksekti (p=0,002). Lenfoma sıklığı (p=0,011) erkeklerde daha yüksek iken, akut lösemi, miyelodisplastik sendrom ve multipl miyelom sıklığında bir fark gözlenmedi. Malign olmayan hematolojik hastalıkların (idiopatik trombositopenik purpura, trombotik trombositopenik purpura) sıklığı kadınlarda daha fazla idi (p=0.030). Bununla birlikte, semptom, bulgular veya acil servis sonuçları açısından cinsiyetler arasında farklılık izlenmedi.
Sonuç
Acil servise başvuran pansitopenili hastalar farklı demografik, klinik ve etiyolojik özellikler göstermektedir. Çalışmamızda önemli oranı ilk kez acilde tanı alan hematolojik malignite , ilaç hipersensitivitesi , enfeksiyon etiyolojik sebepler arasında ilk sıralarda yer almaktadır. Hastaların önemli oranı ileri tetkik ve tedavi için diğer servislere yatırılmaktadır. Pansitopeni ile ilişkili bu özelliklerin bilinmesi erken tanı ve tedaviye olanak sağlayarak hastaların prognozlarının geliştirilmesine yardımcı olabilir.
Introduction Pancytopenia is a haematological disorder characterized by a decrease in all three peripheral blood cell lines and it is a relatively common phenomenon encountered in clinical practice. Pancytopenia is a prominent aspect of several severe and life-threatening diseases, extending from basic drug-induced bone marrow hypoplasia to fatal bone marrow failures and leukemias. The characteristics of patients with pancytopenia assessed in hematology and pathology clinics have been previously evaluated, but pancytopenia patients presenting to the emergency department have not. However, emergency departments frequently serve as the initial point of diagnosis for patients presenting with pancytopenia. The aim of our study was to evaluate the aetiological, clinical and haematological characteristics of patients with pancytopenia admitted to the emergency department of a tertiary care hospital. Material and methods The study included 541 patients who presented to the emergency department with pancytopenia, retrospectively. Age, gender, presence of comorbidities and laboratory data were obtained from patient files. Admission symptoms and findings, etiology of pancytopenia and medication history related to pancytopenia were recorded. Emergency outcomes of the patients were evaluated as ward hospitalization, discharge, ICU hospitalization and exitus. In-hospital mortality rates were evaluated and patients who died within the first 7 days were classified as early mortality. It was planned to compare the descriptive and clinical characteristics of the patients by grouping them according to early mortality and gender. Analyses with a p value below 0.05 were considered significant. Results The mean age of the patients was 63.7 ± 16.0 years (20-96 years). The male/female ratio was 1.2/1. Symptoms related with anemia (weakness, palpitations, pallor, dizziness) were observed in 74.5%, neutropenia (fever) in 36.2% and thrombocytopenia in 19% and of the patients. The most common etiologies of pancytopenia were haematological malignancy (34.9%), drug hypersensitivity (32.0%), infection (14.4%), megaloblastic anemia (8.9%), haematological disease (3.7%), hypersplenism (1.8%) and aplastic anemia (1.1%), and others (11.8%) respectively. The immediate outcome of the patients was ward admission in 71.1%, discharge in 15.1%, and ICU admission in 11.4%. The early hospital mortality rate for the first 7 days was 4.5%. There were no differences between patients who died within the first 7 days and those who survived in terms of demographic characteristics, symptoms and signs, laboratory results, and emergency outcome. The frequency of infection-related pancytopenia was higher in patients who died (p<0.001). The mean age of male patients was higher than that of female patients (p<0.001). The frequency of haematological malignancies was significantly higher in males than females (p=0.002). Among haematological malignancies, the frequency of lymphoma (p=0.011) was higher in males, whereas no difference was observed in the frequency of acute leukemia, myelodysplastic syndrome and multiple myeloma. The frequency of non-malign haematological diseases (idiopathic thrombosis purpura, thrombotic thrombosis purpura) was higher in females (p=0.030). However, there were no differences in symptoms, findings or emergency department outcomes between males and females. Conclusion Patients with pancytopenia presenting to the emergency department show different demographic, clinical and etiological characteristics. In our study, hematological malignancy, drug hypersensitivity, and infection, a significant proportion of which were diagnosed for the first time in the emergency department, are among the top etiological causes. A significant proportion of patients are admitted to other services for further examination and treatment. Knowing these features associated with pancytopenia may help improve the prognosis of patients by allowing early diagnosis and treatment.
Introduction Pancytopenia is a haematological disorder characterized by a decrease in all three peripheral blood cell lines and it is a relatively common phenomenon encountered in clinical practice. Pancytopenia is a prominent aspect of several severe and life-threatening diseases, extending from basic drug-induced bone marrow hypoplasia to fatal bone marrow failures and leukemias. The characteristics of patients with pancytopenia assessed in hematology and pathology clinics have been previously evaluated, but pancytopenia patients presenting to the emergency department have not. However, emergency departments frequently serve as the initial point of diagnosis for patients presenting with pancytopenia. The aim of our study was to evaluate the aetiological, clinical and haematological characteristics of patients with pancytopenia admitted to the emergency department of a tertiary care hospital. Material and methods The study included 541 patients who presented to the emergency department with pancytopenia, retrospectively. Age, gender, presence of comorbidities and laboratory data were obtained from patient files. Admission symptoms and findings, etiology of pancytopenia and medication history related to pancytopenia were recorded. Emergency outcomes of the patients were evaluated as ward hospitalization, discharge, ICU hospitalization and exitus. In-hospital mortality rates were evaluated and patients who died within the first 7 days were classified as early mortality. It was planned to compare the descriptive and clinical characteristics of the patients by grouping them according to early mortality and gender. Analyses with a p value below 0.05 were considered significant. Results The mean age of the patients was 63.7 ± 16.0 years (20-96 years). The male/female ratio was 1.2/1. Symptoms related with anemia (weakness, palpitations, pallor, dizziness) were observed in 74.5%, neutropenia (fever) in 36.2% and thrombocytopenia in 19% and of the patients. The most common etiologies of pancytopenia were haematological malignancy (34.9%), drug hypersensitivity (32.0%), infection (14.4%), megaloblastic anemia (8.9%), haematological disease (3.7%), hypersplenism (1.8%) and aplastic anemia (1.1%), and others (11.8%) respectively. The immediate outcome of the patients was ward admission in 71.1%, discharge in 15.1%, and ICU admission in 11.4%. The early hospital mortality rate for the first 7 days was 4.5%. There were no differences between patients who died within the first 7 days and those who survived in terms of demographic characteristics, symptoms and signs, laboratory results, and emergency outcome. The frequency of infection-related pancytopenia was higher in patients who died (p<0.001). The mean age of male patients was higher than that of female patients (p<0.001). The frequency of haematological malignancies was significantly higher in males than females (p=0.002). Among haematological malignancies, the frequency of lymphoma (p=0.011) was higher in males, whereas no difference was observed in the frequency of acute leukemia, myelodysplastic syndrome and multiple myeloma. The frequency of non-malign haematological diseases (idiopathic thrombosis purpura, thrombotic thrombosis purpura) was higher in females (p=0.030). However, there were no differences in symptoms, findings or emergency department outcomes between males and females. Conclusion Patients with pancytopenia presenting to the emergency department show different demographic, clinical and etiological characteristics. In our study, hematological malignancy, drug hypersensitivity, and infection, a significant proportion of which were diagnosed for the first time in the emergency department, are among the top etiological causes. A significant proportion of patients are admitted to other services for further examination and treatment. Knowing these features associated with pancytopenia may help improve the prognosis of patients by allowing early diagnosis and treatment.
Açıklama
Anahtar Kelimeler
Pansitopeni, Acil servis, Etiyolojik, Klinik, Hematolojik özellikler, Pancytopenia, Emergency department, Etiological, Clinical, Haemotlogical features
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kurnaz, D. (2023). Bir üniversite hastanesi erişkin acil servisine başvuran pansitopenili hastaların etiyolojik, klinik ve hematolojik karakteristikleri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
