Опыт проведения эндоскопии желудочно-кишечного тракта и бронхоскопии у детей с тромбоцитопенией

Abstract

Oncological, hematological and immunological diseases themselves or in the course of treatment are often accompanied by a decrease in the parameters of peripheral blood. If there are indications for endoscopy, the doctor performing the research should necessarily evaluate the safety of the procedure and the risks of bleeding in thrombocytopenia. To date, there are no single hematological criteria in the world for safe endoscopy procedure. The aim of the work is to evaluate the possibility of carrying out endoscopic studies in patients with thrombocytopenia and to determine the indications for blood transfusion therapy. The retrospective analysis included 82 patients aged 2 months to 18 years (median age – 9.6 years), who were treated at the Dmitry Rogachev National Center from January 2016 to March 2017, and who underwent diagnostic endoscopy with a platelet count ≤ 50×109/l or an endopic study with biopsy at a platelet count of ≤ 80×109/l, and 19 patients aged 1–18 years (median – 9.26 years), whom endoscopy was performed with prophylactic platelets transfusion. In the endoscopic examination, contact bleeding was observed in 17% of patients who did not receive prophylactic transfusion of platelets and in 21% of patients who underwent transfusion of platelet suspension prior to the study. When carrying out the diagnostic procedure (bronchoscopy and gastroscopy) with a platelet count of more than 20×109/l (median – 34×109/l), no spontaneous bleeding was observed, as well as minimal hemorrhagic syndrome. A safe endoscopy examination is possible to perform even in patients with thrombocytopenia, but clearly defined indications.