STEPENOVANI DIJAGNOSTIČKI POSTUPAK ZA HRONIČNU NEUTROPENIJU: DA LI JE VREME ZA REGISTAR U SRBIJI?
Hronična idiopatska neutropenija - koraci u dijagnostici
Sažetak
Hronična neutropenija se javlja kada minimum tri meseca broj neutrofila bude ispod 1.8 milijardi /L. Ukoliko neutropenija perzistira duže od tri meseca bez prisutne druge bolesti, izlaganja hemijskim sustancama, zračenju, infekcijama, lekovima inflamacija, različitih lekova, koji mogu da uslove nastanak neutropenije, onda govorimo o hroničnoj idiopatskoj neutropeniji. Prema težini razlikujemo ozbiljne, umereno ozbiljne i blage neutropenije, koje mogu biti sa ili bez ekstrahematoloških manifestacija. Cilj ovog prikaza slučaja je da prezentuje definisani stepenovani pristup kod pacijenta sa pretpostavljenom dijagnozom hronične neutropenije, uključujući pravovremeno prepoznavanje i kontinuirano praćenje pacijenta u skladu sa preporukama Evropske mreže za inovativnu dijagnozu i tretman hronične neutropenije - European Network for Innovative Diagnosis and Treatment of Chronic Neutropenias. Slučaj prikazuje 40-godišnju ženu koja se javila Hematološkoh klinici Univerzitetskog kliničkog centra u Nišu radi redovne kontrole zdravlja i krvne slike. Naime, kod pacijentkinje su u 21.godine, nakon prvog porođaja, uočene neutropenija i anemija. Laboratorijski parametri, izuzev broja neutrofila bili su u fiziološkim granicama. Periferni razmaz krvi takođe nije odstupao od fiziološkog izgleda. Rezultati imunoloških analiza su bili u okviru referentnih vrednosti. Zatim su sprovedeni testovi koji su pokazali su da ne postoji virusna infekcija koja bi mogla da bude uzrok smanjenog broj neutrofila. Punkcija koštane srži je pokazala uredan nalaz. Hronična neutropenija može biti udružena sa nizom ozbiljnih zdravstvenih komplikacija. Stoga sugerišemo uvođenje definisanog pristupa identifikaciji, registrovanju, praćenju pacijenata sa hroničnom neutropenijom kroz centralni registar, slično drugim evropskim zemljama.
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