12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
1317
IDIOPATHIC THROMBOCYTOPENIC PURPURA: PRELIMINARY RESULTS IN 30 PATIENTS
OLDER THAN 65 YEARS
E. Andres, 1 S. Daou, 1 L. Federici, 1 K. Serraj, 1 J. Zimmer, 2 F. Maloisel 1
1 University Hospital, STRASBOURG, France; 2 CRP-Santé, LUXEMBOURG,
Luxembourg
Background. Idiopathic thrombocytopenic purpura (ITP) is not welldocumented
in elderly patients. Aims. Here, we describe data and management
experience of ITP in elderly patients. Methods. The study was
conducted retrospectively among 30 elderly patients (i.e. ≥65 years) followed
since 1985 in the University Hospital of Strasbourg (France). The
analyzed data includes: clinical characteristics, therapies used, their
response rates and side effects at the 6 th month. Results. The mean age
of the patients was 71 years (range, 65 to 82); 12 patients were older than
75 years. The initial presentation included: thrombocytopenia revealed
by a routine blood count in 6 patients (20%), bleeding limited to the skin
in 7 cases (23%) and bleeding in one or more other sites (mucosa or visceral)
in 17 patients (57%). The mean platelet count was 47×10 9 /L (range,
1 to 120). During follow-up, 3 patients (10%) died. Initially, a response
to oral corticosteroid therapy was obtained in all the treated patients
(n=14), but only one third of the patients were responders after 6 months
of follow-up. Adverse effects of corticosteroid therapy were reported in
100% of the patients. Intravenous immunoglobulin represented the initial
treatment in 3 patients; none of them presented any response. Initially,
all splenectomized patients (n=6) showed response to the splenectomy.
But after 6 months of follow-up, none of these patients was still
in complete response. Postoperative complications occurred in 4
patients, including one fatal issue (septic shock). Danazol was given to
5 patients with a response in 60% of the cases. Moderate to severe elevation
of serum aspartate or alanine aminotransferase was reported in
all these patients. Summary/Conclusions. The present results show that
ITP seem to be more severe in elderly patients. They confirm that the
age influences the response and adverse effects of various conventional
therapies and that Danazol may be a potentially effective therapeutic
alternative to splenectomy for elderly ITP patients.
1318
COAGULATION, FIBRINOLYTIC SYSTEM ACTIVATION AND ENDOTHELIAL DYSFUNCTION
IN PATIENTS WITH MITRAL STENOSIS IN SINUS RHYTHM
S. Ayaz, 1 S. Yilmaz, 1 S. Topaloglu, 2 D. Aras2 1 2 Hematology, Yuksek Ihtisas Hospital, ANKARA; Cardiology, Yuksek Ihtisas
Hospital, ANKARA, Turkey
Introduction. Systemic embolism is a important complication in patients
with mitral stenosis. Anticoagulation treatment can prevent this serious
complication in patients with mitral stenosis in atrial fibrilation, but in
sinus rhythm the place of this treatment is in argument. In this study,
our aim is to determine the hemostatic parameters of mitral stenotic
patients in sinus rhythm and also to compare the systemic hemostatic
parameters of patients both in atrial fibrilation with left atrium spontaneous
echo contrast(LASEC) and without LASEC and normal population.
Material and methods. 46 patients with mitral stenosis contributed
to this study. 28 patients were in sinus rhythm and 18 patients were in
atrial fibrillation. None of the patients had left atrial thrombus in transesophageal
echocardiography. We studied systemic venous fibrinogen,
D Dimer, antithrombin, tisuue plasminogen activator(tpa), plasminogen
activator inhibitor-1, von Willebrand factor, platelet factor 4(PF4) in
these patients. Fibrinogen, D Dimer, antithrombin, plasminogen activator
inhibitor-1, von Willebrand factor were mesured by automated coagulometer(BCS
System, Dade-Behring, Germany). Tpa (Biopool, Sveden)
and PF4 (Stago, France) were measured by ELISA method. The patients
were divided into subgroups, first according to their rhythm as sinusal
and atrial fibrillation than those with LASEC and atrial fibrillation, those
without LASEC and sinus rhythm, those without LASEC and atrial fibrillation.
All of these groups were compared. Results. Our results suggest
that fibrinogen, DDimer, antithrombin, von Willebrand factor, platelet
factor 4 levels were greater in sinus rhythm and atrial fibrillation groups
than the control group. This was significant statistically (p