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Abstract
DISORDERS OF HAEMOSTASIS, COMPLICATIONS AND THEIR CORRECTION IN CHILDREN WITH ACUTE LEUKEMIA
Makieieva N. I., Gubar S.O., Koval V. A., Zharkova T. S.
Purpose. To study the significance of capillarotrophic disorders in the development of complications of chemotherapy in children with acute leukemia and the effectiveness of the treatment and prevention of these complications. Patients and methods. Parameters of haemostasis system (plasma, platelet and vascular chains) have been studied in 86 children aged 1 - 17 years with acute leukemia in the dynamics of the disease, before the start and on the background of chemotherapy during the development of infectious and non-infectious complications. The patients received standard therapy according to the BFM protocols were divided into two groups according to the difference in the substitution therapy: group 1 - patients did not receive platelet replacement therapy, group 2 - ones received replacement therapy, including preventive platelet transfusion. The effectiveness of therapy was accessed by comparing the number of complications in patients of both groups. Results. In 100% of patients, severe myelosuppression was observed. A decrease in the number of platelets in the blood lower than 20*109/l was found to be in 43% of patients, agranulocytosis was found in 35%. Patients of the 1st group had bleeding in 33% of cases, anemia of II-III stage of severity in 76%, gastroenterologic inflammation in 21%, respiratory distress syndrome in 33% , pneumonia in 47% , sepsis in 14%, other localization of infection in 13%. In patients of the 2nd group the incidence of complications of chemotherapy and their severity decreased in 2–6 times. The concept of the leading role of thrombocytopenia in the development of stages of capillarotrophic disorders is presented. Conclusions. The results indicate the important role of severe thrombocytopenia and capillarotrophic disorders in the occurrence of infectious and non-infectious complications of chemotherapy in patients with acute leukemia. Adequate replacement therapy with donor platelets reduces the number and severity of complications, increases the effectiveness of treatment.
Key words: acute leukemia, children, complications, correction, haemostasis
Порушення гемостазу, ускладненнята їх корекція у хворихна гостру лейкемію дітей.
Макєєва Н.І., Губар С.О., Коваль В.А., Жаркова Т.С.
Мета: вивчити значимість капілляротрофічних порушень в розвитку ускладнень хіміотерапії у дітей хворих на гостру лейкеміюй ефективність лікування і профілактики цих ускладнень. Пацієнти і методи. У 86 дітей у віці 1 - 17 років хворих на гостру лейкемію вивчені показники системи гемостазу (плазмового, тромбоцитарного та судинної ланок) в динаміці захворювання, до початку і на тлі застосування хіміотерапії при розвитку інфекційних і не інфекційних ускладнень. Хворі отримували стандартну терапію за протоколами BFM були розділені на дві групи за відмінностями в терапії супроводу:
1 група - хворі не отримували замісну терапію тромбоконцентратом, 2 група - отримувала замісну терапію, в тому числі, і превентивну трансфузию тромбоцитів. Ефективність терапії оцінювали порівняням числа ускладнень у пацієнтів обох груп. Результати. У 100% хворих виявлена тяжка мієлосупресія зі зниженням числа тромбоцитів у крові нижче 20 * '10 9 / л у 43%, агранулоцитоз - у 35%. У хворих 1 групи реєстрували кровотечу - у 33%, анемію II-III ступеня тяжкості - у 76%, стоматоезофагоентероколіт - у 21%, респіраторний дистрес-синдром - у 33%, пневмонію - в 47%, сепсис - у 14%, інші локалізації інфекції – у 13% випадків. У хворих 2 групи в 2 - 6 разів зменшилася частота розвитку ускладнень хіміотерапії та їх тяжкість. Представлена концепція провідної ролі тромбоцитопенії в розвитку стадій капілляротрофічних порушень. Висновки. Отримані результати свідчать про важливу роль важкої тромбоцитопенії і капілляротрофічних порушень у виникненні інфекційних і неінфекційних ускладнень хіміотерапії у хворих на гостру лейкемію. Адекватна замісна терапія донорським тромбоконцентратом знижує число і тяжкість ускладнень, підвищує ефективність лікування.
Ключові слова: гемостаз, гостра лейкемія, діти, корекція, ускладнення
Нарушения гемостаза, осложнения и их коррекция у детей сострым лейкозом.
Макеева Н.И., Губарь С.О., Коваль В.А., Жаркова Т.С.
Цель: изучить значимость капилляротрофических нарушений в развитии осложнений химиотерапии у детей больных острым лейкозом и эффективность лечения и профилактики этих осложнений. Пациенты и методы. У 86 детей в возрасте 1 – 17 лет больных острым лейкозом изучены показатели системы гемостаза (плазменного, тромбоцитарного и сосудистого звеньев) в динамике заболевания, до начала и на фоне применения химиотерапии при развитии инфекционных и не инфекционных осложнений. Больные получали стандартную терапию по протоколам BFM были разделены на две группы по различию в проводимой терапии сопровождения: 1 группа – больные не получали заместительную терапию тромбоконцентратом, 2 группа - получала заместительную терапию, в том числе, и превентивную трансфузию тромбоцитов. Эффективность терапии оценивали сравнением числа осложнений у пациентов обеих групп.Результаты. У 100% больных выявлена тяжелая миелосупрессия со снижением числа тромбоцитов в крови ниже 20*10 9/л у 43%, агранулоцитоз – у 35%. У больных І группы регистрировали кровотечение - в 33%, анемия II-III степени тяжести - в 76%, стоматоэзофагоентероколит - в 21%, респираторный дистресс-синдром – в 33%, пневмония – в 47%, сепсис – в 14%, иные локализации инфекции – 13% случаев. У больных II группы в 2 – 6 раз уменьшилась частота развития осложнений химиотерапии и их тяжесть. Представлена концепция ведущей роли тромбоцитопении в развитии стадий капилляротрофических нарушений. Выводы. Полученные результаты свидетельствуют о важной роли тяжелой тромбоцитопении и капилляротрофических нарушений в возникновении инфекционных и неинфекционных осложнений химиотерапии у больных острым лейкозом. Адекватная заместительная терапия донорским тромбоконцентратом снижает число и тяжесть осложнений, повышает эффективность лечения.
Ключевые слова: гемостаз, дети,коррекция, осложнения, острый лейкоз
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