Solmaz Soner, Korur Aslı, Gereklioğlu Çiğdem, Asma Süheyl, Büyükkurt Nurhilal, Kasar Mutlu, Yeral Mahmut, Kozanoğlu İlknur, Boğa Can, Ozdoğu Hakan
Department of Hematology, Adana Hospital of Başkent University, Adana, Turkey.
Department of Family Medicine, Adana Hospital of Başkent University, Adana, Turkey.
Mediterr J Hematol Infect Dis. 2016 Mar 1;8(1):e2016019. doi: 10.4084/MJHID.2016.019. eCollection 2016.
Neutropenic patients are susceptible to any anorectal disease, and symptomatic anorectal disease afflicts 2-32% of oncology patients. Perianal infections are the most feared complication, considering the lack of natural defense against infectious microorganisms. When septic complications develop, the anorectal disease is potentially fatal, especially in neutropenic patients in whom mortality rates range between 11-57%. Although anorectal diseases are a frequent complication with potentially fatal outcomes among patients with hematologic diseases, sufficient data are not available in the literature. In this study, we aimed to investigate the anorectal complications developing during the neutropenic period in patients with hematologic diseases.
A total of 79 patients whose neutropenic period (absolute neutrophil count <500/mcL) continued for 7 days, or longer were included in the study.
A total of 34 patients out of 79 (43%) were detected to develop anorectal complications, of them 6 (7.6%) developed an anorectal infection. The patients were characterized according to the hematological disease and its status (active or not), the type of treatment and the presence of a history of an anorectal pathology before the onset of the hematologic disease. Nineteen (24.1%) patients had the history of anorectal disturbances before diagnosis of the hematologic disease, and recurrence of an anorectal pathology was found in 14 out of 19 patients(73.7%). In addition, the overall mortality rate was higher among the patients who developed anorectal complications compared to another group (41.2% vs. 22.2%, p=0.059).
Anorectal pathology is a common complication with high recurrence rate in neutropenic patients. Perianal infections are important as they can cause life-threatening outcomes although they are relatively rare among all anorectal complications. Therefore perianal signs and symptoms should be meticulously evaluated concerning early diagnosis and treatment.
中性粒细胞减少的患者易患任何肛肠疾病，有症状的肛肠疾病困扰着2%至32%的肿瘤患者。由于缺乏对感染性微生物的天然防御能力，肛周感染是最令人担忧的并发症。当发生败血症并发症时，肛肠疾病可能是致命的，尤其是在中性粒细胞减少的患者中，死亡率在11%至57%之间。尽管肛肠疾病是血液病患者中常见的并发症，且可能导致致命后果，但文献中尚无足够的数据。在本研究中，我们旨在调查血液病患者中性粒细胞减少期发生的肛肠并发症。
本研究共纳入79例中性粒细胞减少期（绝对中性粒细胞计数<500/μL）持续7天或更长时间的患者。
79例患者中有34例（43%）被检测出发生肛肠并发症，其中6例（7.6%）发生了肛肠感染。根据血液病及其状态（活动期或非活动期）、治疗类型以及血液病发病前是否有肛肠疾病史对患者进行了特征描述。19例（24.1%）患者在血液病诊断前有肛肠疾病史，19例患者中有14例（73.7%）出现了肛肠疾病复发。此外，发生肛肠并发症的患者的总体死亡率高于另一组（41.2%对22.2%，p=0.059）。
肛肠疾病是中性粒细胞减少患者常见的并发症，复发率高。肛周感染很重要，因为尽管在所有肛肠并发症中相对少见，但它们可导致危及生命的后果。因此，应仔细评估肛周体征和症状以进行早期诊断和治疗。
