Reticulocyte –thrombocyte relation during the response to the treatment of megaloblastic anemia

Purpose: The reticulocyte count is the exact method in the evaulation of therapeutic response of megaloblastic anemia to the vitamin B-12 treatment. In cases of vitamin B-12 deficiency presented with a combination of anemia/thrombocytopenia or pancytopenia, we aimed to study the therapeutic response of thrombocytes (which have shorter life span than reticulocytes) in relation to reticulocytes.
Material and methods: From 102 patients of megaloblastic anemia due to vitamin B-12 deficiency, who where followed up between January 2005 and August 2009 in our medical department, forty-six patients (who had no blood transfusion) with a combination of anemia/thrombocytopenia or pancytopenia were selected for this study. Pre and post (6th day) of vitamin B-12 treatment, corrected reticulocyte and platelet levels were compared using independent t-test, the paired t-test, and Pearson correlation test (NCSS 2007 software program).
Results: At 6th day of vitamin B-12 treatment (in compare to day 0), there was a significant increase in both platelet counts and corrected reticulocyte rates (63,98±30,28x 103 /mm3 versus 162,63±85,35x 103 /mm3, and 0.57±0.42% versus 4,61±2,66%, p=0,0001, and 0,001, respectively). Also there was a positive correlation between the changes in the corrected reticulocyte rate and the changes in platelet counts (r=0,480, and P=0,001).
Conclusions: Increase in platelet counts can be used (if fascilities for reticulocyte count is not available) as an indicator of early bone marrow response to vitamin B-12 replacement therapy in vitamin B-12 deficiency cases presented with a combination of anemia/thrombocytopenia or pancytopenia. If there is no such post-treatment increase in platelet counts, myelodysplastic syndrome should be excluded by bone marrow aspiration and/or biopsy.

Megaloblastik anemi tedavisine cevapta retikülosit-trombosit iliþkisi

Amaç: Megaloblastik aneminin vitamin B-12 ye cevabýný ölçmede en doðru yöntem, retikülosit sayýmýdýr. Anemi/trombositopeni ya da pansitopeni kombinasyonu ile baþvuran vitamin B-12 eksikliði olgularýnda tedavi cevabýný ölçmede hayat siklusu daha kýsa olan trombositlerin retiküsitlere kýyasla nasýl davrandýðýný deðerlendirmek istedik.
Gereç ve yöntem: Ocak 2005-Aðustos 2009 tarihleri arasýnda servisimizde vitamin B-12 eksikliðine baðlý megaloblastik anemi tanýsýyla incelenen 102 hasta içinden anemi/trombositopeni ya da pansitopeni kombinasyonu olan transfüzyon yapýlmamýþ 46 hasta çalýþmaya alýndý. Vitamin B-12 tedavisi öncesi bakýlan düzeltilmiþ retikülosit yüzdeleri ve trombosit sayýlarý, tedavinin 6. günündeki deðerlerle karþýlaþtýrýldý. Ýstatistik analizi baðýmsýz (t) testi, eþlendirilmiþ (t) testi, Pearson korelasyon testi kullanýlarak NCSS 2007 paket proðramý ile yapýldý.
Bulgular: Tedavi öncesi ortalama trombosit sayýsý 63,98±30,28x 103/mm3, tedavinin 6. gününde 162,63±85,35x 103/mm3’e çýkarken (p=0,0001) düzeltilmiþ retikülosit ortalama deðeri tedavi öncesi %0.57±0.42’den tedavinin 6. gününde %4,61±2,66 ya yükseldi (P=0,0001). Düzeltilmiþ retikülosit deðiþim yüzdesi ile trombositteki deðiþim yüzdesi arasýnda anlamlý derecede pozitif korelasyon (r=0,480, P=0,001) gözlendi.
Sonuçlar: Vitamin B-12 eksikliðine baðlý megaloblastik anemi/trombositopeni veya pansitopeni kombinasyonu ile baþvuranlarda tedavinin erken döneminde kemik iliði cevabýný deðerlendirmede retikülosit sayma imkaný olmayan koþullarda trombositlerdeki artýþ. Cevap olarak kabul edilebilir. Þayet bu artýþ yoksa myelodisplastik sendromlarý araþtýrmak için kemik iliði aspirasyon ve biopsisi yapýlmalýdýr.