RESUMEN
Hematopoietic stem cell transplantation (HSCT) is an effective therapy for acute leukemia (AL). Relapse represents the main cause of mortality. Isolated extramedullary relapse (iEMR) is atypical and has been related to better outcomes. Here we describe the clinical characteristics and outcomes of AL relapse after HSCT in our study population and analyze the impacts of different types of relapse on survival outcomes. This retrospective, multicenter study included 124 patients age ≥15 years with AL who underwent HSCT between 2004 and 2019. At diagnosis, 66.1% of the patients had lymphocytic AL, 19.7% presented with high-risk features, and 18.5% had extramedullary disease (EMD). At HSCT, 83.1% of the patients were in complete remission (CR), and 44.8% had negative measurable residual disease (MRD). The vast majority of donors were related (96%), including 48.4% HLA-matched and 47.6% haploidentical. Myeloablative conditioning was provided to 80.6% of patients. The median overall survival (OS) was 15 months (95% confidence interval [CI] 9.9 to 20.1 months). Factors associated with improved OS were adolescent and young adult (AYA) patient (P = .035), first or second CR (P = .026), and chronic graft-versus-host disease (GVHD) (P < .001). Acute GVHD grade III-IV (P = .009) was associated with increased mortality. The median relapse-free survival was 13 months (95% CI, 7.17 to 18.8 months); early disease status (P = .017) and chronic GVHD (P < .001) had protective roles. Sixty-eight patients (55%) relapsed after HSCT, with a median time to relapse of 6 months (95% CI, 3.6 to 8.4 months). iEMR was reported in 16 patients (23.5%). The most commonly involved extramedullary sites were the central nervous system and skin. Compared to patients with bone marrow relapse, all patients with iEMR had a diagnosis of acute lymphoid leukemia (P = .008), and 93.8% belonged to the AYA group; regarding pre-HSCT characteristics, iEMR patients had higher rates of negative MRD (P = .06) and a history of EMD (P = .009). Seventy-seven percent of relapsed patients received additional treatment with curative intent. The median OS after relapse (OSr) was 4 months (95% CI, 2.6 to 5.4 months). Factors related to increased OSr included lymphoid phenotype (P = .03), iEMR (P = .0042), late relapse (≥6 months) (P = .014), receipt of systemic therapy including second HSCT (P < .001), and response to therapy (P < .001). Rates of relapse and iEMR were higher than those previously reported in other studies. Advanced disease, reduced-intensity conditioning, and a diminished graft-versus-leukemia effect were factors influencing these findings. At relapse, presenting with iEMR after 6 months and receiving intensive therapy with adequate response were associated with better outcomes. Our results strongly suggest that a personalized approach to treating patients with HSCT is needed to counterbalance specific adverse factors and can positively impact clinical outcomes.
Asunto(s)
Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda , Humanos , Enfermedad Aguda , Enfermedad Crónica , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/terapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , América Latina , Leucemia Mieloide Aguda/terapia , Recurrencia , Estudios Retrospectivos , Adolescente , Adulto JovenRESUMEN
Introducción: los cambios en el ácido desoxirribonucleico se conocen como mutaciones, estas dan lugar a los polimorfismos, los cuales generan variación alélica entre individuos y diversidad de la misma especie. Se ha sugerido que los polimorfismos genéticos en los mediadores inmunitarios desempeñan un papel fundamental en la patogénesis de muchos trastornos autoinmunes, como en la púrpura trombocitopénica inmune, siendo esta el tipo más común de púrpura trombocitopénica y, a menudo, se diagnostica como un tipo de trastorno autoinmune, debido a la destrucción de las plaquetas mediadas por el sistema inmunitario. Objetivo: realizar una revisión bibliográfica sobre el papel de los polimorfismos genéticos y su influencia en el desarrollo de la púrpura trombocitopénica inmune. Métodos: se realizó revisión literaria en inglés y español en PubMed y Elsevier, desde marzo hasta mayo del 2021, con el uso de combinación de palabras clave y términos MeSH, como púrpura trombocitopénica y polimorfismos genéticos. Se realizó análisis y resumen de la literatura encontrada. Conclusión: la púrpura trombocitopénica inmune es considerada como una patología multifactorial, causada por factores ambientales y genéticos, dentro de los cuales se encuentran los polimorfismos para los mediadores inmunitarios que pueden llevar a una exacerbación de la enfermedad o no intervenir en la misma.
Introduction: Changes in deoxyribonucleic acid are known as mutations, these give place to polymorphisms, which generate allelic variation between individuals and provide diversity among same species. Genetic polymorphisms in immune mediators have been suggested to play a key role in the pathogenesis of many autoimmune disorders, such as immune thrombocytopenic purpura, this being the most common type of thrombocytopenic purpura and is often diagnosed as a type of autoimmune disorder, due to the destruction of platelets mediated by the immune system. Objective: To execute a bibliographic review on the role of genetic polymorphisms and their influence on the development of immune thrombocytopenic purpura. Methods: A literary review in English and Spanish was performed in PubMed and Elsevier from March to May 2021, with the use of a combination of keywords and MeSH terms such as Thrombocytopenic Purpura and genetic polymorphisms. Analysis and summary of the literature found was executed. Conclusion: Immune thrombocytopenic purpura is considered a multifactorial pathology, caused by environmental and genetic factors, among which are polymorphisms for immune mediators that can lead to an exacerbation of the disease or not intervene in the same.
Asunto(s)
Polimorfismo Genético , Púrpura Trombocitopénica , Plaquetas , Factores de Riesgo , Enfermedades HematológicasRESUMEN
The objective of this study was to evaluate the relationship between oral health status and its impact on quality of life, and to suggest dental management strategies in patients undergoing antineoplastic therapy for onco-hematological diseases. A retrospective study including 33 individuals (age 9-79 yr) was conducted. It was observed that the dimensions related to physical pain, psychological discomfort, and social incapacity had statistically significant values. The most frequently performed dental treatments were periodontal treatment (45.45 %), dental restoration (36.36 %), tooth extractio n (33.33 %), and endodontic treatment (24.24 %). Thus, poor oral health directly affects the quality of life. Dental management should consider the aspects of the disease and antineoplastic treatment while aiming for safe and effective dental care.
El objetivo de este estudio fue evaluar la relación entre el estado de salud oral y su impacto en la calidad de vida, y sugerir estrategias de manejo odontológico en pacientes sometidos a terapia anti-neoplásica por enfermedades onco-hematológicas. Se realizó un estudio retrospectivo que incluyó a 33 personas (de 9 a 79 años de edad). Se observó que las dimensiones relacionadas con dolor físico, malestar psicológico e incapacidad social tuvieron valores estadísticamente significativos. Los tratamientos dentales realizados con mayor frecuencia fueron el tratamiento periodontal (45,45 %), la restauración dental (36,36 %), la extracción dentaria (33,33 %) y el tratamiento endodóntico (24,24 %). Así, la mala salud oral afecta directamente la calidad de vida. El tratamiento dental debe tener en cuenta los aspectos de la enfermedad y el tratamiento antineoplásico mientras se busca una atención dental segura y eficaz.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Salud Bucal , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/epidemiología , Calidad de Vida , Prevalencia , Encuestas y Cuestionarios , Estudios Retrospectivos , Neoplasias Hematológicas/microbiología , Neoplasias Hematológicas/tratamiento farmacológicoRESUMEN
Introducción: La esplenectomía es un tratamiento estandarizado en niños con trombocitopenia. El método de laparoscopía, en este tratamiento, minimiza los procesos post-operatorios y se ha difundido su aplicación en la comunidad científica. El objetivo del presente estudio es realizar una descripción de la casuística y utilidad de la esplenectomía laparoscópica en los niños con patología hematológica. Métodos: El presente estudio observacional, retrospectivo se realizó en el Hospital Pediátrico Baca Ortiz. Se revisaron expedientes clínicos de los últimos 10 años de pacientes con indicación de esplenectomía quirúrgica. Se analizan variables demográficas, clínicas y de resultados. Se utiliza estadística descriptiva. Resultados: Ingresaron al estudio 14 pacientes que tuvieron una esplenectomía quirúrgica vía laparoscópica. La mayoría de estos pacientes son del sexo femenino, con patologías hematológicas como esferocitosis y púrpura trombocitopénica idiopática (PTI). En el 50% se realizó colecistectomía además de esplenectomía. El tiempo quirúrgico varió de 60 a 120 minutos. Conclusiones: La esplenectomía laparoscópica es considerada una técnica compleja dentro de los procedimientos de laparoscopia, pero es ideal para los pacientes con patología hematológica, por lo que es la técnica de elección. Una ventaja de la esplenectomía laparoscópica es el menor tiempo de recuperación y hospitalización, con heridas quirúrgicas más pequeñas.
Introduction: Splenectomy is a standardized treatment in children with thrombocytopenia. The laparoscopic method, in this treatment, minimizes post-operative processes and its application has become widespread in the scientific community. The objective of this study is to describe the casuistry and usefulness of laparoscopic splenectomy in children with hematological pathology. Methods: This retrospective, observational study was conducted at Baca Ortiz Pediatric Hospital. Medical records of the last 10 years of patients with an indication for surgical splenectomy were reviewed. Demographic, clinical and outcome variables are analyzed. Descriptive statistics are used. Results: Fourteen patients who had a laparoscopic surgical splenectomy entered the study. Most of these patients are female, with hematological pathologies such as spherocytosis and idiopathic thrombocytopenic purpura (ITP). In 50% a cholecystectomy was performed in addition to splenectomy. The surgical time ranged from 60 to 120 minutes. Conclusions: Laparoscopic splenectomy is considered a complex technique within laparoscopic procedures, but it is ideal for patients with hematological pathology, so it is the technique of choice. An advantage of laparoscopic splenectomy is the shorter recovery time and hospitalization, with smaller surgical wounds
Asunto(s)
Humanos , Esplenectomía , Enfermedades HematológicasRESUMEN
ABSTRACT INTRODUCTION: Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, particularly neutropenic patients with hematological malignancies. In this study, we aimed to verify the epidemiology and diagnosis of IFIs in patients with hematologic problems at a tertiary hospital in Goiânia-GO, Brazil. METHODS: Data from 117 patients, involving 19 cases of IFIs, were collected. The collected data included diagnosis methods, demographics, clinical characteristics, and in vitro susceptibility to different antifungal agents. Among the 19 cases, 12 were classified as proven IFI and 7 as probable invasive aspergillosis with detection of galactomannan in blood and presence of lung infiltrates in radiographic images. Logistic regression analysis showed that the proven and probable IFIs were associated with increased risk of death. Statistical analysis demonstrated that age, sex, and underlying disease were not independently associated with risk of death in IFI patients. RESULTS: Most bloodstream isolates of Candida spp. exhibited low minimum inhibitory concentrations (MICs) to all antifungal agents tested. Voriconazole and amphotericin had the lowest MICs for Aspergillus spp. and Fusarium spp., but Fusarium spp. showed the least susceptibility to all antifungals tested. Amphotericin B, fluconazole, and itraconazole were found to be inactive in vitro against Acremonium kiliense; but this fungus was sensitive to voriconazole. CONCLUSIONS: Considering the high number of IFI cases, with crude mortality rate of 6%, we could conclude that IFIs remain a common infection in patients with hematological malignancies and underdiagnosed ante mortem. Thus, IFIs should be monitored closely.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Infecciones Fúngicas Invasoras/microbiología , Enfermedades Hematológicas/microbiología , Aspergillus/aislamiento & purificación , Aspergillus/efectos de los fármacos , Acremonium/aislamiento & purificación , Acremonium/efectos de los fármacos , Candida/aislamiento & purificación , Candida/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Prevalencia , Sensibilidad y Especificidad , Huésped Inmunocomprometido , Infecciones Fúngicas Invasoras/diagnóstico , Fusarium/aislamiento & purificación , Fusarium/efectos de los fármacos , Mananos/sangre , Persona de Mediana Edad , Antifúngicos/farmacologíaRESUMEN
OBJECTIVES: To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive fusariosis. METHODS: We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. RESULTS: Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive fusariosis (p = 0.04). CONCLUSIONS: Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies.
Asunto(s)
Fusariosis/microbiología , Fusarium/aislamiento & purificación , Piel/microbiología , Adolescente , Adulto , Anciano , Antifúngicos/uso terapéutico , Femenino , Fusariosis/diagnóstico , Fusariosis/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
El objetivo de este trabajo fue determinar la utilidad clínica de los índices plaquetarios en la caracterización etiológica de las trombocitopenias. Se trata de un estudio descriptivo, retrospectivo y transversal. En pacientes controles se establecieron valores de referencia para número de plaquetas e índices plaquetarios, y éstos se evaluaron en pacientes donde coexistía trombocitopenia con algún desorden oncohematológico (linfoma no Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásico, púrpura trombocitopénica inmune). La evaluación de laboratorio fue realizada al momento del diagnóstico, aún libre de tratamiento. En los casos de Púrpura Inmune (disminución de Volumen Plaquetario - Plaquetocrito, y aumento de Amplitud Plaquetaria); Leucemia Mieloide Crónica (aumento de la Amplitud Plaquetaria) y Linfoma no Hodgkin o Síndrome Mielodisplásico (disminución del Plaquetocrito), los índices plaquetarios podrían ser usados como herramienta diagnóstica orientadora. En cambio, no podrían contribuir al momento de diferenciar entre leucemias agudas, dado que no presentan diferencias significativas. Frente a un diagnóstico presuntivo de síndrome mielodiasplásico o leucemia mieloide aguda, el valor de Volumen Plaquetario Medio (VPM) podría contribuir como herramienta orientadora al diagnóstico, ya que sería más bajo en la leucemia aguda. El análisis de los resultados sugiere que en la práctica clínica los índices plaquetarios podrían contribuir de un modo significativo a la confirmación del diagnóstico.(AU)
The aim of this study was to determine the clinical utility of platelet indices in the etiological characterization of thrombocytopenia. It was a descriptive, retrospective and cross-sectional study. In control patients, reference values (platelet count and platelet indices) were established and they were used to assess platelet indices in patients where thrombocytopenia coexisted with some oncohematologic disorders (non-Hodgkin Lymphoma, Hodgkin Lymphoma, acute leukemia, chronic leukemia, myelodysplastic syndrome, immune thrombocytopenic purpura). Laboratory evaluation was performed at still treatment-free diagnosis. In the cases of Immune Purpura, (decreased platelet volume- plateletcrit, and increased platelet distribution width) Chronic Myeloid Leukemia (increased platelet distribution width) and non-Hodgkin lymphoma or myelodysplastic syndrome (decreased plateletcrit), platelet indices could be used as a "guiding diagnostic tool". However, they could not contribute to the differenciation between acute leukemias since they do not present any significant differences. In view of a presumptive diagnosis of mielodysplastic syndrome or acute myeloid leukemia, mean platelet value (MPV) could contribute to the diagnosis, since it would be lower in acute leukemia. The analysis of the results suggests that in clinical practice, platelet indices may contribute significantly to the confirmation of the diagnosis.(AU)
O objetivo deste trabalho foi determinar a utilidade clínica dos índices plaquetários na caracterizagáo etiológica das trombocitopenias. Trata-se de um estudo descritivo, retrospectivo e transversal. Em pacientes controle foram estabelecidos valores de referencia para número de plaquetas e índices plaquetários, e eles foram avaliados em pacientes onde coexistia trombocitopenia com alguma desordem onco-hematológica (linfoma náo Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásica, púrpura trombocitopenia imune). A avaliagáo de laboratório foi realizada no momento do diagnóstico, ainda livre de tratamento. Nos casos de Púrpura Imune (diminuigáo de Volume Plaquetario - Plaquetócrito, e aumento de Amplitude Plaquetária); Leucemia Mieloide Crónica (aumento da Amplitude Plaquetária) e Linfoma náo Hodgkin ou Síndrome Mielodisplásica (diminuigáo do Plaquetócrito), os índices plaquetários poderiam ser usados como ferramenta diagnóstica orientadora. Entretanto, náo poderiam contribuir no momento de diferenciar entre leucemias agudas, visto que náo apresentam diferengas significativas. Diante de um diagnóstico presuntivo de síndrome mielodiasplásica ou leucemia mieloide aguda, o valor de Volume Plaquetário Médio (VPM) poderia contribuir como ferramenta orientadora para o diagnóstico, devido a que seria mais baixo na leucemia aguda. A análise dos resultados sugere que na prática clínica os índices plaquetários poderiam contribuir de um modo significativo para a confirmagáo do diagnóstico.(AU)
RESUMEN
El objetivo de este trabajo fue determinar la utilidad clínica de los índices plaquetarios en la caracterización etiológica de las trombocitopenias. Se trata de un estudio descriptivo, retrospectivo y transversal. En pacientes controles se establecieron valores de referencia para número de plaquetas e índices plaquetarios, y éstos se evaluaron en pacientes donde coexistía trombocitopenia con algún desorden oncohematológico (linfoma no Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásico, púrpura trombocitopénica inmune). La evaluación de laboratorio fue realizada al momento del diagnóstico, aún libre de tratamiento. En los casos de Púrpura Inmune (disminución de Volumen Plaquetario - Plaquetocrito, y aumento de Amplitud Plaquetaria); Leucemia Mieloide Crónica (aumento de la Amplitud Plaquetaria) y Linfoma no Hodgkin o Síndrome Mielodisplásico (disminución del Plaquetocrito), los índices plaquetarios podrían ser usados como herramienta diagnóstica orientadora. En cambio, no podrían contribuir al momento de diferenciar entre leucemias agudas, dado que no presentan diferencias significativas. Frente a un diagnóstico presuntivo de síndrome mielodiasplásico o leucemia mieloide aguda, el valor de Volumen Plaquetario Medio (VPM) podría contribuir como herramienta orientadora al diagnóstico, ya que sería más bajo en la leucemia aguda. El análisis de los resultados sugiere que en la práctica clínica los índices plaquetarios podrían contribuir de un modo significativo a la confirmación del diagnóstico.(AU)
The aim of this study was to determine the clinical utility of platelet indices in the etiological characterization of thrombocytopenia. It was a descriptive, retrospective and cross-sectional study. In control patients, reference values (platelet count and platelet indices) were established and they were used to assess platelet indices in patients where thrombocytopenia coexisted with some oncohematologic disorders (non-Hodgkin Lymphoma, Hodgkin Lymphoma, acute leukemia, chronic leukemia, myelodysplastic syndrome, immune thrombocytopenic purpura). Laboratory evaluation was performed at still treatment-free diagnosis. In the cases of Immune Purpura, (decreased platelet volume- plateletcrit, and increased platelet distribution width) Chronic Myeloid Leukemia (increased platelet distribution width) and non-Hodgkin lymphoma or myelodysplastic syndrome (decreased plateletcrit), platelet indices could be used as a "guiding diagnostic tool". However, they could not contribute to the differenciation between acute leukemias since they do not present any significant differences. In view of a presumptive diagnosis of mielodysplastic syndrome or acute myeloid leukemia, mean platelet value (MPV) could contribute to the diagnosis, since it would be lower in acute leukemia. The analysis of the results suggests that in clinical practice, platelet indices may contribute significantly to the confirmation of the diagnosis.(AU)
O objetivo deste trabalho foi determinar a utilidade clínica dos índices plaquetários na caracterizagáo etiológica das trombocitopenias. Trata-se de um estudo descritivo, retrospectivo e transversal. Em pacientes controle foram estabelecidos valores de referencia para número de plaquetas e índices plaquetários, e eles foram avaliados em pacientes onde coexistia trombocitopenia com alguma desordem onco-hematológica (linfoma náo Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásica, púrpura trombocitopenia imune). A avaliagáo de laboratório foi realizada no momento do diagnóstico, ainda livre de tratamento. Nos casos de Púrpura Imune (diminuigáo de Volume Plaquetario - Plaquetócrito, e aumento de Amplitude Plaquetária); Leucemia Mieloide Crónica (aumento da Amplitude Plaquetária) e Linfoma náo Hodgkin ou Síndrome Mielodisplásica (diminuigáo do Plaquetócrito), os índices plaquetários poderiam ser usados como ferramenta diagnóstica orientadora. Entretanto, náo poderiam contribuir no momento de diferenciar entre leucemias agudas, visto que náo apresentam diferengas significativas. Diante de um diagnóstico presuntivo de síndrome mielodiasplásica ou leucemia mieloide aguda, o valor de Volume Plaquetário Médio (VPM) poderia contribuir como ferramenta orientadora para o diagnóstico, devido a que seria mais baixo na leucemia aguda. A análise dos resultados sugere que na prática clínica os índices plaquetários poderiam contribuir de um modo significativo para a confirmagáo do diagnóstico.(AU)
RESUMEN
El objetivo de este trabajo fue determinar la utilidad clínica de los índices plaquetarios en la caracterización etiológica de las trombocitopenias. Se trata de un estudio descriptivo, retrospectivo y transversal. En pacientes controles se establecieron valores de referencia para número de plaquetas e índices plaquetarios, y éstos se evaluaron en pacientes donde coexistía trombocitopenia con algún desorden oncohematológico (linfoma no Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásico, púrpura trombocitopénica inmune). La evaluación de laboratorio fue realizada al momento del diagnóstico, aún libre de tratamiento. En los casos de Púrpura Inmune (disminución de Volumen Plaquetario - Plaquetocrito, y aumento de Amplitud Plaquetaria); Leucemia Mieloide Crónica (aumento de la Amplitud Plaquetaria) y Linfoma no Hodgkin o Síndrome Mielodisplásico (disminución del Plaquetocrito), los índices plaquetarios podrían ser usados como herramienta diagnóstica orientadora. En cambio, no podrían contribuir al momento de diferenciar entre leucemias agudas, dado que no presentan diferencias significativas. Frente a un diagnóstico presuntivo de síndrome mielodiasplásico o leucemia mieloide aguda, el valor de Volumen Plaquetario Medio (VPM) podría contribuir como herramienta orientadora al diagnóstico, ya que sería más bajo en la leucemia aguda. El análisis de los resultados sugiere que en la práctica clínica los índices plaquetarios podrían contribuir de un modo significativo a la confirmación del diagnóstico.
The aim of this study was to determine the clinical utility of platelet indices in the etiological characterization of thrombocytopenia. It was a descriptive, retrospective and cross-sectional study. In control patients, reference values (platelet count and platelet indices) were established and they were used to assess platelet indices in patients where thrombocytopenia coexisted with some oncohematologic disorders (non-Hodgkin Lymphoma, Hodgkin Lymphoma, acute leukemia, chronic leukemia, myelodysplastic syndrome, immune thrombocytopenic purpura). Laboratory evaluation was performed at still treatment-free diagnosis. In the cases of Immune Purpura, (decreased platelet volume- plateletcrit, and increased platelet distribution width) Chronic Myeloid Leukemia (increased platelet distribution width) and non-Hodgkin lymphoma or myelodysplastic syndrome (decreased plateletcrit), platelet indices could be used as a "guiding diagnostic tool". However, they could not contribute to the differenciation between acute leukemias since they do not present any significant differences. In view of a presumptive diagnosis of mielodysplastic syndrome or acute myeloid leukemia, mean platelet value (MPV) could contribute to the diagnosis, since it would be lower in acute leukemia. The analysis of the results suggests that in clinical practice, platelet indices may contribute significantly to the confirmation of the diagnosis.
O objetivo deste trabalho foi determinar a utilidade clínica dos índices plaquetários na caracterizagáo etiológica das trombocitopenias. Trata-se de um estudo descritivo, retrospectivo e transversal. Em pacientes controle foram estabelecidos valores de referencia para número de plaquetas e índices plaquetários, e eles foram avaliados em pacientes onde coexistia trombocitopenia com alguma desordem onco-hematológica (linfoma náo Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásica, púrpura trombocitopenia imune). A avaliagáo de laboratório foi realizada no momento do diagnóstico, ainda livre de tratamento. Nos casos de Púrpura Imune (diminuigáo de Volume Plaquetario - Plaquetócrito, e aumento de Amplitude Plaquetária); Leucemia Mieloide Crónica (aumento da Amplitude Plaquetária) e Linfoma náo Hodgkin ou Síndrome Mielodisplásica (diminuigáo do Plaquetócrito), os índices plaquetários poderiam ser usados como ferramenta diagnóstica orientadora. Entretanto, náo poderiam contribuir no momento de diferenciar entre leucemias agudas, visto que náo apresentam diferengas significativas. Diante de um diagnóstico presuntivo de síndrome mielodiasplásica ou leucemia mieloide aguda, o valor de Volume Plaquetário Médio (VPM) poderia contribuir como ferramenta orientadora para o diagnóstico, devido a que seria mais baixo na leucemia aguda. A análise dos resultados sugere que na prática clínica os índices plaquetários poderiam contribuir de um modo significativo para a confirmagáo do diagnóstico.