Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report

sayin, serhat; ASİL, Mehmet; CIFCI, Sami; UÇAR, Ramazan; ÖZBEK, Orhan; DEMİR, ALİ; ATASEVEN, Hüseyin; Polat, Hakki; biyik, murat

Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report

Mehmet ASİL, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Gastroenteroloji Bölümü, Konya, Türkiye)

Murat BIYIK, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Gastroenteroloji Bölümü, Konya, Türkiye)

Sami CIFCI, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Gastroenteroloji Bölümü, Konya, Türkiye)

Serhat SAYIN, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Konya, Türkiye)

Ramazan UÇAR, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Konya, Türkiye)

Orhan ÖZBEK, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Radyoloji Anabilim Dalı, Konya, Türkiye)

Hüseyin ATASEVEN, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Gastroenteroloji Bölümü, Konya, Türkiye)

Hakkı POLAT, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Gastroenteroloji Bölümü, Konya, Türkiye)

Ali DEMİR (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Gastroenteroloji Bölümü, Konya, Türkiye)

Viral Hepatitis Journal

2 1

Yıl: 2015 Cilt: 21 Sayı: 3 Sayfa Aralığı: 102 - 105 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report

Öz:

Kronik hepatit C nedeniyle interferon içeren tedavi rejimleri uygulanan hastalarda ilaçlara bağlı yan etkilerle sıklıkla karşılaşılmaktadır. Bu yan etkiler bazen ilaçların suboptimal dozlarda verilmesine hatta tedavinin kesilmesine neden olabilmektedir. İnterferon alan hastalarda trombositopeni sık görülür ve tedaviyi zorlaştırır. Biz burada Pegile interferon+ribavirin+telaprevir üçlü tedavisi alan ve tedaviyi etkileyen trombositopeni tedavisi için splenik embolizasyon uygulanılan hepatit C virüs (HCV) (+) sirotik bir hastayı sunmayı amaçladık. Kırk yedi yaşında kadın hasta kliniğimizde HCV(+) siroz nedeniyle 6 yıldır takip edilmekteydi. Altı yıl önce 48 hafta pegylated interferon (PEGIFN)+ribavirin tedavisi almış ve tedavi sonrası relaps saptanmıştı. Proteaz inhibitörü içeren 3'lü tedavi protokollerinin genotip 1b hastalarda ülkemizde de onaylanmasından sonra hastaya telaprevir içeren 3'lü tedavi protokolü planlandı. Hastanın tedavi öncesi laboratuvar tetkikleri Child A sirozla uyumluydu. Abdominal ultrasonografide kronik karaciğer hastalığı bulguları ve splenomegali saptandı. Tedavi öncesi HCV RNA 756000 copy/ml, Hb: 11,8 g/dL, WBC: 4600/?L, Trombosit: 64000/?L idi. Hastaya Peg IFN ?-2a 135 mcg/hafta, ribavirin 1000 mg/gün ve telaprevir 3x750 mg/gün başlandı. İki hafta içerisinde trombosit sayımı önce 42000 /?L ve ardından 14000 /?L'ye kadar düştü. PEG-IFN dozu kademeli olarak 67,5 mcg/haftaya kadar azaltıldı. Trombositopeni nedeniyle hastaya parsiyel splenik embolizasyon uygulandı. Bir hafta içerisinde trombosit sayısı 45000/?L'ye yükseldi ve PEG-IFN dozu tekrar 135 mcg/haftaya arttırıldı. Tedavinin geri kalan kısmında trombosit sayısı yaklaşık 60000/?L civarında seyretti ve hasta 48 haftalık tedaviyi başarıyla tamamladı. Hastaya tedavi sonu ve tedavi bitiminden 12 hafta sonra bakılan HCV RNA (-) olarak saptandı. PEG-IFN içeren üçlü tedavi tedavi protokolleri uygulanacak olan sirotik hastalarda trombositopeni tedavisinde splenik embolizasyon minimal invaziv bir seçenek olarak kullanılabilir.

Anahtar Kelime:

Konular: Gastroenteroloji ve Hepatoloji

Parsiyel Splenik Embolizasyon Üçlü Tedavi Alan Sirotik Hastalarda Trombositopeniyle Mücadelede Bir Seçenek Olabilir: Bir Olgu Sunumu

Öz:

Various drug-related side effects are frequently encountered in patients receiving interferon-containing treatment regimens for chronic hepatitis C. Such side effects sometimes necessitate drugs be given in suboptimal doses or even discontinuation of the treatment. Thrombocytopenia is frequent in patients receiving interferon and complicates treatment course. Here, we present a case of hepatitis C virus (HCV) (+) cirrhotic patient in whom splenic embolization was successfully performed in order to overcome thrombocytopenia associated with pegylated interferon (PEG-IFN)+ribavirin+telaprevir triple therapy. A 47-year-of woman was being followed in our clinic due to HCV-related cirrhosis for 6 years. She was given PEG-IFN+ribavirin treatment for 48 weeks 6 years ago and HCV infection relapsed. After the approval of protease inhibitorcontaining triple therapy regimens in genotype 1b HCV (+) patients in our country, such treatment was planned. Laboratory investigations were consistent with Child class A cirrhosis. Abdominal ultrasound showed the presence of cirrhosis and splenomegaly. HCV RNA was 756000 copy/ml. Pretreatment hematologic parameters were as follows; Hb: 11.8 g/dL, WBC: 4600/?L and platelet count: 64000/?L. Treatment was started with PEG IFN ?-2a 135 mcg/week, ribavirin 1000 mg/day and telaprevir 3x750 mg/day. Platelet count dropped gradually to 42000 /?L and than to 14000 /?L in two weeks. PEG-IFN dose was progressively reduced up to 67.5 mcg/week. To overcome thrombocytopenia, partial splenic embolization was performed. Platelet count increased to 45000 /?L in 1 week and PEG-IFN dose was increased back to 135 mcg/week. Throughout the rest of the treatment, platelet count remained around 60.000 /?L and she successfully completed a 48-week treatment course. Both end-treatment and 12th week post-treatment HCV RNA were negative. Treatment of severe thrombocytopenia with splenic embolization may be an effective minimally invasive option in HCV (+) cirrhotic patients in whom PEG-IFN-containing triple treatment regimens are given.

Anahtar Kelime:

Konular: Gastroenteroloji ve Hepatoloji

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık

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APA	ASİL M, biyik m, CIFCI S, sayin s, UÇAR R, ÖZBEK O, ATASEVEN H, Polat H, DEMİR A (2015). Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. , 102 - 105.
Chicago	ASİL Mehmet,biyik murat,CIFCI Sami,sayin serhat,UÇAR Ramazan,ÖZBEK Orhan,ATASEVEN Hüseyin,Polat Hakki,DEMİR ALİ Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. (2015): 102 - 105.
MLA	ASİL Mehmet,biyik murat,CIFCI Sami,sayin serhat,UÇAR Ramazan,ÖZBEK Orhan,ATASEVEN Hüseyin,Polat Hakki,DEMİR ALİ Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. , 2015, ss.102 - 105.
AMA	ASİL M,biyik m,CIFCI S,sayin s,UÇAR R,ÖZBEK O,ATASEVEN H,Polat H,DEMİR A Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. . 2015; 102 - 105.
Vancouver	ASİL M,biyik m,CIFCI S,sayin s,UÇAR R,ÖZBEK O,ATASEVEN H,Polat H,DEMİR A Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. . 2015; 102 - 105.
IEEE	ASİL M,biyik m,CIFCI S,sayin s,UÇAR R,ÖZBEK O,ATASEVEN H,Polat H,DEMİR A "Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report." , ss.102 - 105, 2015.
ISNAD	ASİL, Mehmet vd. "Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report". (2015), 102-105.

APA	ASİL M, biyik m, CIFCI S, sayin s, UÇAR R, ÖZBEK O, ATASEVEN H, Polat H, DEMİR A (2015). Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. Viral Hepatitis Journal, 21(3), 102 - 105.
Chicago	ASİL Mehmet,biyik murat,CIFCI Sami,sayin serhat,UÇAR Ramazan,ÖZBEK Orhan,ATASEVEN Hüseyin,Polat Hakki,DEMİR ALİ Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. Viral Hepatitis Journal 21, no.3 (2015): 102 - 105.
MLA	ASİL Mehmet,biyik murat,CIFCI Sami,sayin serhat,UÇAR Ramazan,ÖZBEK Orhan,ATASEVEN Hüseyin,Polat Hakki,DEMİR ALİ Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. Viral Hepatitis Journal, vol.21, no.3, 2015, ss.102 - 105.
AMA	ASİL M,biyik m,CIFCI S,sayin s,UÇAR R,ÖZBEK O,ATASEVEN H,Polat H,DEMİR A Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. Viral Hepatitis Journal. 2015; 21(3): 102 - 105.
Vancouver	ASİL M,biyik m,CIFCI S,sayin s,UÇAR R,ÖZBEK O,ATASEVEN H,Polat H,DEMİR A Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report. Viral Hepatitis Journal. 2015; 21(3): 102 - 105.
IEEE	ASİL M,biyik m,CIFCI S,sayin s,UÇAR R,ÖZBEK O,ATASEVEN H,Polat H,DEMİR A "Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report." Viral Hepatitis Journal, 21, ss.102 - 105, 2015.
ISNAD	ASİL, Mehmet vd. "Partial Splenic Embolization may be an Option to Overcome Thrombocytopenia Interfering with Triple Therapy in HCV (+) Cirrhotic Patients: A Case Report". Viral Hepatitis Journal 21/3 (2015), 102-105.