Publication: Solid tümörlü hastaların kanında görülen koagülasyon anormallikleri
Abstract
SOLİD TÜMÖRLÜ HASTALARIN KANINDA GÖRÜLEN KOAGÜLASYON ANORMALLİKLERİ Hiperkoagülasyon ve koagülapati gibi bazı koagülasyon anormallikleri önemli morbidite ve mortalite sebepleridir. Bu nedenle araştırmamızda GATA Haydarpaşa Eğitim hastanesi, Kartal Devlet Hastanesi Tıbbi Onkoloji Klinikleri ve Kartal Devlet Hastanesi Poliklinik birimlerinde tedavi görmekte olan solid tümörlü hastalardaki koagülasyon anormalliklerinin belirlenmesi amaçlanmıştır. Bu koagülasyon parametreleri; trombosit sayısı, kanama zamanı, pıhtılaşma zamanı, protrombin zamanı, aktive parsiyel trombin zamanı, antitrombin III, fibrinojen, protein C ve protein S şeklinde sıralanabilir. Bu araştırmada genel hasta grubu için elde edilen parametreler kontrol değerleriyle karşılaştırıldı. Karşılaştırma sonucu protein S ve protrombin zamanı parametrelerinin kontrol değerlerinden yüksek olduğu saptandı. Diğer parametrelerle kontrol değerleri karşılaştırıldığında ise önemli bir farklılık olamadığı belirlendi. Ayrıca ileri ve erken evreli kanser hastalarının koagülasyon parametrelerinin karşılaştırılması protrombin zamanının erken evredeki kanserli hastalarda yüksek olduğunu gösterdi. Tüm kanser hastaları arasında gastrointestinal sistem ve akciğer kanserli hastaların önemli iki grubu oluşturduğu bilinmektedir. Bundan dolayı bu iki grup hastadan elde edilen veriler diğer kanserli hastalardan elde edilen değerlerle ve kontrol değerleriyle karşılaştırıldığında akciğer kanserli hastalara ait protrombin zamanı koagülasyon değerlerinin kontrol değerlerinden farklı olduğu saptandı. Diğer yandan bu hastaların fibrinojen seviyelerinin kontrol değerlerinden önemli seviyede yüksek olduğu belirlendi. Bunlara ek olarak trombosit, fibrinojen, antitrombin III protein S ve protrombin zamanının da kontrol değerleriyle karşılaştırıldığında gastrointestinal sistem kanserli hastalarda oldukça yüksek olduğu belirlendi. Ayrıca bu parametreler akciğer, gastrointestinal sistem kanserli hastalar ve diğer kanserli hastalardan elde edilen verilerle karşılaştırıldı. Bu karşılaştırma sonucunda gastrointestinal sistem hastalarıyla diğer kanser hastaları arasında önemli bir fark belirlenemedi. Bununla birlikte akciğer kanserli hastalardaki fibrinojen seviyesinin diğer kanser hastalarındakinden yüksek olduğu saptandı. Erken ve ileri safha kanserli hastalardan elde edilen veriler normal zaman değerleriyle karşılaştırıldığında kanama zamanının erken akciğer kanser evresindeki hastalarda daha kısa olduğu tespit edildi. Gastrointestinal sistem kanserli hastalarla yapılan benzer bir karşılaştırma antitrombin III seviyesinin ileri evredeki kanser hastalarında önemli derecede azaldığını gösterdi. Daha önce yapılan araştırmalar koagülasyon anormalliklerinin kanserli hastalarda görülme olasılığının yüksek olduğunu göstermiştir. Bu çalışmada da koagülasyon anormalliklerinin kanser hastalarında ortaya çıkma olasılığının, yüksek olduğu saptandı. Elde edilen veriler koagülasyon anormalliklerinin önlenmesi için alınacak olan bazı önemli tedbirlerin kanser tedavisindeki başarıya katkı sağlayabileceğini vurgulamaktadır. Koagülasyon anormalliklerinin belirlenmesi ve bunların önlenmesi için alınacak tedbirler, kanserli hastaların hem tedavi hem de yaşam sürelerini uzatabilecektir. Şubat 2005 Dilek OBA
COAGULATION ABNORMALITIES IN THE BLOOD OF PATIENTS WITH SOLID TUMORS Some of the coagulation abnormalities such as hypercoagulation and coagulapathy are important causes of morbidity and mortality. Therefore, the aim of this project was to determine the coagulation abnormalities in those patients with solid tumors taking treatment in GATA Haydarpaşa Education Hospital , Kartal State Hospital Medical Oncology Clinic and Kartal State Hospital Policlinic units. These coagulation parametres are; the number of thrombocytes, blooding time, clotting time, prothrombin time, activated partial thromboplastin time, antithrombin III, fibrinogen, protein S and protein C. The parametres obtained for general patient group were compared with control values. As a result, the protein S and prothrombin time parametres was found to be higher than control values. However differences between other parametres and control values was found to be insignificant. Furthermore, a comparation of coagulation parametres was also carried out in those patients with advanced stage and early stage of cancer. As a result prothrombin time was found to be higher in patients with early stage of cancer. It is known that patients with gastrointestinal system and lung cancer are most important group of all cancer patients. Therefore, when the data obtained for these two groups were compared with those of other cancer patients and the control values it was shown that prothrombin time of coagulation parametres in lung cancer patients was different from control values. On the other hand the fibrinogen level of these patients was shown to be significantly higher than that of the control values. Moreover, thrombocyte, fibrinogen, antithrombin III, protein S and prothrombin time were also significantly higher in patients with gastrointestinal system cancer as compared with control values. In addition, a comparison of these parametres are also made between lung, gastrointestinal system and other cancer patients. There was no important difference between gastrointestinal system cancer patients and the patients with other types of cancer. However the fibrinogen level of lung cancer patients was found to be higher as compared to those other cancer patients. The data obtained for early and advanced stage lung cancer patients showed that as compared to the normal time value the blooding time was shorter in early stage lung cancer patients. A similar comparison with gastrointestinal system cancer patients indicated that antithrombin III level significantly decreased in advanced stage cancer patients. From the early studies it is known that the coagulation abnormalities are higher in cancer patients. Similarly the coagulation abnormalities was also shown to be higher in some of the patients studied during the work of this project. The data obtained from this project may suggest that in order to improve cancer treatment some important precautions should be taken to prevent coagulation abnormalities. Determination of coagulation abnormalities and the precautions taken to prevent them, will probably elongate the treatment period as well as the lifetime of those cancer patients. February 2005 Dilek OBA
COAGULATION ABNORMALITIES IN THE BLOOD OF PATIENTS WITH SOLID TUMORS Some of the coagulation abnormalities such as hypercoagulation and coagulapathy are important causes of morbidity and mortality. Therefore, the aim of this project was to determine the coagulation abnormalities in those patients with solid tumors taking treatment in GATA Haydarpaşa Education Hospital , Kartal State Hospital Medical Oncology Clinic and Kartal State Hospital Policlinic units. These coagulation parametres are; the number of thrombocytes, blooding time, clotting time, prothrombin time, activated partial thromboplastin time, antithrombin III, fibrinogen, protein S and protein C. The parametres obtained for general patient group were compared with control values. As a result, the protein S and prothrombin time parametres was found to be higher than control values. However differences between other parametres and control values was found to be insignificant. Furthermore, a comparation of coagulation parametres was also carried out in those patients with advanced stage and early stage of cancer. As a result prothrombin time was found to be higher in patients with early stage of cancer. It is known that patients with gastrointestinal system and lung cancer are most important group of all cancer patients. Therefore, when the data obtained for these two groups were compared with those of other cancer patients and the control values it was shown that prothrombin time of coagulation parametres in lung cancer patients was different from control values. On the other hand the fibrinogen level of these patients was shown to be significantly higher than that of the control values. Moreover, thrombocyte, fibrinogen, antithrombin III, protein S and prothrombin time were also significantly higher in patients with gastrointestinal system cancer as compared with control values. In addition, a comparison of these parametres are also made between lung, gastrointestinal system and other cancer patients. There was no important difference between gastrointestinal system cancer patients and the patients with other types of cancer. However the fibrinogen level of lung cancer patients was found to be higher as compared to those other cancer patients. The data obtained for early and advanced stage lung cancer patients showed that as compared to the normal time value the blooding time was shorter in early stage lung cancer patients. A similar comparison with gastrointestinal system cancer patients indicated that antithrombin III level significantly decreased in advanced stage cancer patients. From the early studies it is known that the coagulation abnormalities are higher in cancer patients. Similarly the coagulation abnormalities was also shown to be higher in some of the patients studied during the work of this project. The data obtained from this project may suggest that in order to improve cancer treatment some important precautions should be taken to prevent coagulation abnormalities. Determination of coagulation abnormalities and the precautions taken to prevent them, will probably elongate the treatment period as well as the lifetime of those cancer patients. February 2005 Dilek OBA