First-Step Results of Children Presenting with Bleeding Symptoms or Abnormal Coagulation Tests in an Outpatient Clinicİsmail Yıldız1, Ayşegül Ünüvar2, İbrahim Kamer3, Serap Karaman2, Ezgi Uysalol2, Ayşe Kılıç1, Fatma Oğuz4, Emin Ünüvar11İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, İstanbul, Turkey
2İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul, Turkey
3İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
4İstanbul University Institute of Child Health, Division of Ambulatory Pediatrics, İstanbul, Turkey
Objective: Mild bleeding symptoms are commonly seen in the general population. The aim of this study was to determine the final clinical and laboratory features of children referred for a first evaluation with a suspected bleeding disorder in the pediatric outpatient clinic of İstanbul University.
Materials and Methods: The medical records of 26,737 outpatients who were admitted to the Division of Ambulatory Pediatrics between 31 October 2011 and 31 October 2012 were evaluated retrospectively. Ninety-nine patients were initially diagnosed as having probable bleeding disorders and were followed up. The symptoms of bleeding in addition to coagulation tests were analyzed.
Results: Of the 99 patients, 52 (52.5%) were male and 47 were female, and the mean age of the entire study group was 9.1±4.1 years (minimum-maximum: 2-18 years). Major bleeding symptoms were epistaxis in 36 patients (36.4%), easy bruising in 32 (32.3%), and menorrhagia in 6 (6.1%). After initial tests ordered by the pediatrician, 36 of 99 patients (36.4%) were diagnosed as having bleeding disorders that included von Willebrand disease in 12 (12.1%), hemophilia A or B in 9 (9.1%), and other rare factor deficiencies in 9 (9.1%). Six patients (6.1%) were found to have combined deficiencies. Seven of 36 patients had a family history of bleeding.
Conclusion: Among the patients referred for bleeding disorders, 36.4% were diagnosed with a bleeding disorder with the help of primary screening tests ordered in the outpatient clinic. Keywords: Children, Blood coagulation, Hemophilia, Inherited coagulopathies, Epistaxis, Menorrhagia
Polikliniğe Kanama Belirtileri veya Anormal Koagülasyon Testleri Nedeniyle Başvuran Olgularda Birinci Basamak Değerlendirme Sonuçlarıİsmail Yıldız1, Ayşegül Ünüvar2, İbrahim Kamer3, Serap Karaman2, Ezgi Uysalol2, Ayşe Kılıç1, Fatma Oğuz4, Emin Ünüvar11İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Ambulatory Pediatrics, İstanbul, Turkey
2İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul, Turkey
3İstanbul University İstanbul Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
4İstanbul University Institute of Child Health, Division of Ambulatory Pediatrics, İstanbul, Turkey
Amaç: Hafif kanama bozukluğu belirtileri toplumda sık görülmektedir. Bu çalışmanın amacı İstanbul Üniversitesi İstanbul Tıp Fakültesi Genel Pediatri Polikliniği’ne kanama bozukluğu şüphesi ile sevk edilen hastaların klinik ve laboratuvar özelliklerini belirlemektir.
Gereç ve Yöntemler: 31 Ekim 2011 ile 31 Ekim 2012 tarihleri arasında kanama bozukluğu şüphesiyle yönlendirilen 99 hastanın tıbbi kayıtları incelenmiştir. Başvuru semptomları ile pıhtılaşma testlerinin sonuçları değerlendirilmiştir.
Bulgular: Olguların 47’si kız çocuğu olup ve yaş ortalaması 9,1±4,1 yıl (2-18 yıl) idi. Kanama semptomları 36 hastada (%36,4) burun kanaması, 32 (%32,3) hastada kolay morarma ve 6 hastada (%6,1) menoraji idi. Birinci basamak testleri sonrasında, 99 hastanın 36’sında (%36,4) primer kanama bozukluğu saptandı. Bunlardan 12’sinde (%12,1) von Willebrand hastalığı, 9’unda (%9,1) hemofili A veya B, 9’unda (%9,1) diğer nadir faktör eksiklikleri ve 6 hastada (%6,1) kombine faktör eksiklikleri saptandı. Otuz altı hastanın 7’sinde ailede kanama öyküsü vardı.
Sonuç: Kanama bozukluğu şüphesi ile sevk edilen hastaların %36,4’ünde birinci basamak koagulasyon testleri ışığında kanama bozukluklarından biri saptandı. Anahtar Kelimeler: Çocuk, Koagülasyon, Hemofili, Kalıtsal koagülopatiler, Epistaksis, Menoraji
İsmail Yıldız, Ayşegül Ünüvar, İbrahim Kamer, Serap Karaman, Ezgi Uysalol, Ayşe Kılıç, Fatma Oğuz, Emin Ünüvar. First-Step Results of Children Presenting with Bleeding Symptoms or Abnormal Coagulation Tests in an Outpatient Clinic. Turk J Hematol. 2015; 32(4): 338-343
Corresponding Author: İsmail Yıldız, Türkiye |
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