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TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM

Yıl 2017, Cilt: 15 Sayı: 3, 44 - 48, 01.12.2017

Melike Sezgin Evim Birol Baytan Adalet Meral Güneş

Öz

Trombosit sayısının
450.000/mm3 üzerinde olması trombositoz olarak kabul edilir. Nedenlerine
göre sekonder ya da primer olarak gruplandırılır.  Çocukluk çağında genellikle trombositozun
nedeni sekonderdir ve neden olan hastalığın kontrol altına alınması ile
trombositoz geriler. Sekonder trombositoz kendini sınırlayan bir durumdur. Nadiren
ve özellikle altta yatan bir risk faktörü var ise tromboemboliye neden olur.
Myeloproliferatif hastalıklar içinde gruplandırılan primer trombositozlar çocukluk
çağında çok nadirdir. Primer trombositozda tromboembolik olaylar en önemli
mortalite ve morbidite nedenidir. Primer trombositozlu hastaların bir kısmı
kanama bulguları ile gelebilir.


APPROACH TO CHILDREN WITH
THROMBOCYTOSIS

SUMMARY:

The platelet count
above 450.000/mm3 is defined as thrombocytosis. According to the
underlying causes, thrombocytosis is classified as primary (essential) or
secondary (reactive) thrombocytosis. In childhood, the most common causes of
thrombocytosis are secondary reasons. Secondary thrombcytosis is a self-limited
disease. It resolves with control of the underlying disorder. Secondary thrombocytosis
usually does not result in thromboembolic events. Thrombembolic complications occur
usually in patients who have additional risk factors. Primary thrombocytosis is
grouped under the myeloproliferative diseases and is extremely rare in childhood.
Thromboembolic events in primary  thrombocytosis
are the most important causes of mortality and morbidity. Some cases with
primary thrombocytosis may present with bleeding symptoms.







Key
words: Thrombocytosis, Childhood

Anahtar Kelimeler

Trombositoz Çocuk

Kaynakça

  • 1. Sutor AH. Thrombocytosis. In: Lilleyman JS, Hann IM, Blanchette VS(eds). Pediatric Hematology. Churchill Livingstone, London, Dinburgh, New York. Philadelphia. Sydney, Toronto 1999;455-64.
  • 2. Hasle H. Incidence of essential thrombocythaemia in children. Br J Haematol. 2000;110:751.
  • 3. Bleeker JS, Hogan WJ.Thrombocytosis: diagnostic evaluation, thrombotic risk stratification, and risk-based management strategies. Thrombosis. 2011;2011:536062.
  • 4. Griesshammer M, Bangerter M, Sauer T, Wennauer R, Bergmann L, Heimpel H. Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count. J Intern Med. 1999;245:295-300.
  • 5. Matsubara K, Fukaya T, Nigami H, Harigaya H, Hirata T, Nozaki et al.. Age-dependent changes in the incidence and etiology of childhood thrombocytosis. Acta Haematol. 2004;111:132-7.
  • 6. Dame C. Developmental biology of thrombopoietin in the human fetus and neonate. Acta Paediatr Suppl. 2002;91:54-65.
  • 7. Sola MC, Du Y, Hutson AD, Christensen RD. Dose-response relationship of megakaryocyte progenitors from the bone marrow of thrombocytopenic and non-thrombocytopenic neonates to recombinant thrombopoietin. Br J Haematol. 2000;110:449-53.
  • 8. Garoufi A, Voutsioti K, Tsapra H, Karpathios T, Zeis PM. Reactive thrombocytosis in children with upper urinary tract infections. Acta Paediatr. 2001;90:448-9.
  • 9. Kilpi T, Anttila M, Kallio MJ, Peltola H. Thrombocytosis and thrombocytopenia in childhood bacterial meningitis. Pediatr Infect Dis J. 1992;11:456-60.
  • 10. Kaser A, Brandacher G, Steurer W, Kaser S, Offner FA, Zoller H et al. Interleukin-6 stimulates thrombopoiesis through thrombopoietin: role in inflammatory thrombocytosis. Blood. 2001;98:2720-5.
  • 11. Wolber EM, Fandrey J, Frackowski U, Jelkmann W. Hepatic thrombopoietin mRNA is increased in acute inflammation. Thromb Haemost. 2001;86:1421-4.
  • 12. Wilson DB. Thrombocytosis. In: Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux SE (eds). Hematology of İnfancy and Childhood. 7th edition. Philedelphia: Saunders Elsevier; 2009;1577-8.
  • 13. Papa A, Danese S, Piccirillo N, Toriani-Terenzi C, Bartolozzi F, Piscaglia AC et al. Thrombopoietin serum levels in patients with inflammatory bowel disease with and without previous thromboembolic events. Hepatogastroenterology. 2003;50:132-5.
  • 14. de Benedetti F, Massa M, Robbioni P, Ravelli A, Burgio GR, Martini A. Correlation of serum interleukin-6 levels with joint involvement and thrombocytosis in systemic juvenile rheumatoid arthritis. Arthritis Rheum. 1991;34:1158-63.
  • 15. Dickerhoff R, von Ruecker A. Thrombozytose im Kindesalter. Differential diagnose und klinische Bedeutung. Paediatrishche Praxis 1991;41:25-8.
  • 16. Streja E, Kovesdy CP, Greenland S, Kopple JD, McAllister CJ, Nissenson AR et al. Erythropoietin, iron depletion, and relative thrombocytosis: a possible explanation for hemoglobin-survival paradox in hemodialysis. Am J Kidney Dis. 2008;52:727-36.
  • 17. Geddis AE, Kaushansky K. Cross-reactivity between erythropoietin and thrombopoietin at the level of Mpl does not account for the thrombocytosis seen in iron deficiency. J Pediatr Hematol Oncol. 2003;25:919-20.
  • 18. Komura E, Matsumura T, Kato T, Tahara T, Tsunoda Y, Sawada T. Thrombopoietin in patients with hepatoblastoma. Stem Cells. 1998;16:329-33.
  • 19. Blatt J, Penchansky L, Horn M. Thrombocytosis as a presenting feature of acute lymphoblastic leukemia in childhood. Am J Hematol. 1989;31:46-9.
  • 20. Köksal N, Hacimustafaoğlu M, Bağci S, Celebi S. Meropenem in neonatal severe infections due to multiresistant gram-negative bacteria. Indian J Pediatr. 2001;68:15-9.
  • 21. Bruel H, Chabrolle JP, el Khoury E, Poinsot J, el Forzi N, Amusini P et al. Thrombocytosis and cholestasis in a newborn treated with zidovudine. Arch Pediatr. 2001;8:893-4.
  • 22. Buss DH, Stuart JJ, Lipscomb GE. The incidence of thrombotic and hemorrhagic disorders in association with extreme thrombocytosis: an analysis of 129 cases. Am J Hematol. 1985;20:365-72.
  • 23. Shebl SS, el-Sharkawy HM, el-Fadaly NH. Haemostatic disorders in nonsplenectomized and splenectomized thalassaemic children. East Mediterr Health J. 1999 ;5:1171-7.
  • 24. Edstrom CS, Christensen RD. Evaluation and treatment of thrombosis in the neonatal intensive care unit. Clin Perinatol. 2000;27:623-41.
  • 25. Cervantes F. Management of essential thrombocythemia. Hematology Am Soc Hematol Educ Program. 2011;2011:215-21.
  • 26. Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA et al. Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert panel. Blood. 2007;110:1092-7.
  • 27. Savage DG, Szydlo RM, Goldman JM. Clinical features at diagnosis in 430 patients with chronic myeloid leukaemia seen at a referral centre over a 16-year period. Br J Haematol. 1997;96:111-6.
  • 28. Baxter EJ, Scott LM, Campbell PJ, East C, Fourouclas N, Swanton S et al. Cancer Genome Project Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005;365:1054-61.
  • 29. Kralovics R, Passamonti F, Buser AS, Teo SS, Tiedt R, Passweg JR et al. A gain-of-function mutation of JAK2 in myeloproliferative disorders. N Engl J Med. 2005;352:1779-90.
  • 30. Beer PA, Campbell PJ, Scott LM, Bench AJ, Erber WN, Bareford D et al. MPL mutations in myeloproliferative disorders: analysis of the PT-1 cohort. Blood. 2008;112:141-9.
  • 31. Pardanani AD, Levine RL, Lasho T, Pikman Y, Mesa RA, Wadleigh M et al. MPL515 mutations in myeloproliferative and other myeloid disorders: a study of 1182 patients. Blood. 2006;108:3472-6.
  • 32. Antonioli E, Guglielmelli P, Poli G, Bogani C, Pancrazzi A, Longo G et al. Myeloproliferative Disorders Research Consortium (MPD-RC). Influence of JAK2V617F allele burden on phenotype in essential thrombocythemia. Haematologica. 2008;93:41-8.
  • 33. Vannucchi AM, Antonioli E, Guglielmelli P, Pancrazzi A, Guerini V, Barosi G et al. Characteristics and clinical correlates of MPL 515W>L/K mutation in essential thrombocythemia. Blood. 2008;112:844-7.
  • 34. Passamonti F, Rumi E, Arcaini L, Boveri E, Elena C, Pietra D et al. Prognostic factors for thrombosis, myelofibrosis, and leukemia in essential thrombocythemia: a study of 605 patients. Haematologica. 2008;93:1645-51.
  • 35. Kiladjian JJ, Rain JD, Bernard JF, Briere J, Chomienne C, Fenaux P. Long-term incidence of hematological evolution in three French prospective studies of hydroxyurea and pipobroman in polycythemia vera and essential thrombocythemia. Semin Thromb Hemost. 2006;32417-21.
  • 36. Dror Y, Blanchette VS. Essential thrombocythaemia in children. Br J Haematol. 1999;107:691-8.
  • 37. Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. Br J Haematol. 2005;129:165-77.
  • 38. Besses C, Cervantes F, Pereira A, Florensa L, Solé F, Hernández-Boluda JC et al. Major vascular complications in essential thrombocythemia: a study of the predictive factors in a series of 148 patients. Leukemia. 1999;13:150-4.
  • 39. van Genderen PJ, Michiels JJ. Erythromelalgia: a pathognomonic microvascular thrombotic complication in essential thrombocythemia and polycythemia vera. Semin Thromb Hemost. 1997;23:357-63.
  • 40. van Genderen PJ, Prins FJ, Michiels JJ, Schrör K. Thromboxane-dependent platelet activation in vivo precedes arterial thrombosis in thrombocythaemia: a rationale for the use of low-dose aspirin as an antithrombotic agent. Br J Haematol. 1999;104:438-41.
  • 41. Elliott MA, Tefferi A. Thrombosis and haemorrhage in polycythaemia vera and essential thrombocythaemia. Br J Haematol. 2005;128:275-90.
  • 42. Wolanskyj AP, Schwager SM, McClure RF, Larson DR, Tefferi A. Essential thrombocythemia beyond the first decade: life expectancy, long-term complication rates, and prognostic factors. Mayo Clin Proc. 2006;81:159-66.
  • 43. Bazzan M, Tamponi G, Schinco P, Vaccarino A, Foli C, Gallone G et al. Thrombosis-free survival and life expectancy in 187 consecutive patients with essential thrombocythemia. Ann Hematol. 1999;78:539-43.
  • 44. Carobbio A, Thiele J, Passamonti F, Rumi E, Ruggeri M, Rodeghiero F et al. Risk factors for arterial and venous thrombosis in WHO-defined essential thrombocythemia: an international study of 891 patients. Blood. 2011;117:5857-9.
  • 45. van Genderen PJ, Budde U, Michiels JJ, van Strik R, van Vliet HH. The reduction of large von Willebrand factor multimers in plasma in essential thrombocythaemia is related to the platelet count. Br J Haematol. 1996;93:962-5.
  • 46. Ruggeri M, Finazzi G, Tosetto A, Riva S, Rodeghiero F, Barbui T. No treatment for low-risk thrombocythaemia: results from a prospective study. Br J Haematol. 1998;103:772-7.
  • 47. Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995 Apr 27;332:1132-6.
  • 48. Finazzi G, Ruggeri M, Rodeghiero F, Barbui T. Efficacy and safety of long-term use of hydroxyurea in young patients with essential thrombocythemia and a high risk of thrombosis. Blood. 2003;101:3749.
  • 49. Storen EC, Tefferi A. Long-term use of anagrelide in young patients with essential thrombocythemia. Blood. 2001;97:863-6.
  • 50. Greist A. The role of blood component removal in essential and reactive thrombocytosis. Ther Apher. 2002;6:36-44.

Yıl 2017, Cilt: 15 Sayı: 3, 44 - 48, 01.12.2017

Melike Sezgin Evim Birol Baytan Adalet Meral Güneş

Öz

Kaynakça

  • 1. Sutor AH. Thrombocytosis. In: Lilleyman JS, Hann IM, Blanchette VS(eds). Pediatric Hematology. Churchill Livingstone, London, Dinburgh, New York. Philadelphia. Sydney, Toronto 1999;455-64.
  • 2. Hasle H. Incidence of essential thrombocythaemia in children. Br J Haematol. 2000;110:751.
  • 3. Bleeker JS, Hogan WJ.Thrombocytosis: diagnostic evaluation, thrombotic risk stratification, and risk-based management strategies. Thrombosis. 2011;2011:536062.
  • 4. Griesshammer M, Bangerter M, Sauer T, Wennauer R, Bergmann L, Heimpel H. Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count. J Intern Med. 1999;245:295-300.
  • 5. Matsubara K, Fukaya T, Nigami H, Harigaya H, Hirata T, Nozaki et al.. Age-dependent changes in the incidence and etiology of childhood thrombocytosis. Acta Haematol. 2004;111:132-7.
  • 6. Dame C. Developmental biology of thrombopoietin in the human fetus and neonate. Acta Paediatr Suppl. 2002;91:54-65.
  • 7. Sola MC, Du Y, Hutson AD, Christensen RD. Dose-response relationship of megakaryocyte progenitors from the bone marrow of thrombocytopenic and non-thrombocytopenic neonates to recombinant thrombopoietin. Br J Haematol. 2000;110:449-53.
  • 8. Garoufi A, Voutsioti K, Tsapra H, Karpathios T, Zeis PM. Reactive thrombocytosis in children with upper urinary tract infections. Acta Paediatr. 2001;90:448-9.
  • 9. Kilpi T, Anttila M, Kallio MJ, Peltola H. Thrombocytosis and thrombocytopenia in childhood bacterial meningitis. Pediatr Infect Dis J. 1992;11:456-60.
  • 10. Kaser A, Brandacher G, Steurer W, Kaser S, Offner FA, Zoller H et al. Interleukin-6 stimulates thrombopoiesis through thrombopoietin: role in inflammatory thrombocytosis. Blood. 2001;98:2720-5.
  • 11. Wolber EM, Fandrey J, Frackowski U, Jelkmann W. Hepatic thrombopoietin mRNA is increased in acute inflammation. Thromb Haemost. 2001;86:1421-4.
  • 12. Wilson DB. Thrombocytosis. In: Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux SE (eds). Hematology of İnfancy and Childhood. 7th edition. Philedelphia: Saunders Elsevier; 2009;1577-8.
  • 13. Papa A, Danese S, Piccirillo N, Toriani-Terenzi C, Bartolozzi F, Piscaglia AC et al. Thrombopoietin serum levels in patients with inflammatory bowel disease with and without previous thromboembolic events. Hepatogastroenterology. 2003;50:132-5.
  • 14. de Benedetti F, Massa M, Robbioni P, Ravelli A, Burgio GR, Martini A. Correlation of serum interleukin-6 levels with joint involvement and thrombocytosis in systemic juvenile rheumatoid arthritis. Arthritis Rheum. 1991;34:1158-63.
  • 15. Dickerhoff R, von Ruecker A. Thrombozytose im Kindesalter. Differential diagnose und klinische Bedeutung. Paediatrishche Praxis 1991;41:25-8.
  • 16. Streja E, Kovesdy CP, Greenland S, Kopple JD, McAllister CJ, Nissenson AR et al. Erythropoietin, iron depletion, and relative thrombocytosis: a possible explanation for hemoglobin-survival paradox in hemodialysis. Am J Kidney Dis. 2008;52:727-36.
  • 17. Geddis AE, Kaushansky K. Cross-reactivity between erythropoietin and thrombopoietin at the level of Mpl does not account for the thrombocytosis seen in iron deficiency. J Pediatr Hematol Oncol. 2003;25:919-20.
  • 18. Komura E, Matsumura T, Kato T, Tahara T, Tsunoda Y, Sawada T. Thrombopoietin in patients with hepatoblastoma. Stem Cells. 1998;16:329-33.
  • 19. Blatt J, Penchansky L, Horn M. Thrombocytosis as a presenting feature of acute lymphoblastic leukemia in childhood. Am J Hematol. 1989;31:46-9.
  • 20. Köksal N, Hacimustafaoğlu M, Bağci S, Celebi S. Meropenem in neonatal severe infections due to multiresistant gram-negative bacteria. Indian J Pediatr. 2001;68:15-9.
  • 21. Bruel H, Chabrolle JP, el Khoury E, Poinsot J, el Forzi N, Amusini P et al. Thrombocytosis and cholestasis in a newborn treated with zidovudine. Arch Pediatr. 2001;8:893-4.
  • 22. Buss DH, Stuart JJ, Lipscomb GE. The incidence of thrombotic and hemorrhagic disorders in association with extreme thrombocytosis: an analysis of 129 cases. Am J Hematol. 1985;20:365-72.
  • 23. Shebl SS, el-Sharkawy HM, el-Fadaly NH. Haemostatic disorders in nonsplenectomized and splenectomized thalassaemic children. East Mediterr Health J. 1999 ;5:1171-7.
  • 24. Edstrom CS, Christensen RD. Evaluation and treatment of thrombosis in the neonatal intensive care unit. Clin Perinatol. 2000;27:623-41.
  • 25. Cervantes F. Management of essential thrombocythemia. Hematology Am Soc Hematol Educ Program. 2011;2011:215-21.
  • 26. Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA et al. Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert panel. Blood. 2007;110:1092-7.
  • 27. Savage DG, Szydlo RM, Goldman JM. Clinical features at diagnosis in 430 patients with chronic myeloid leukaemia seen at a referral centre over a 16-year period. Br J Haematol. 1997;96:111-6.
  • 28. Baxter EJ, Scott LM, Campbell PJ, East C, Fourouclas N, Swanton S et al. Cancer Genome Project Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005;365:1054-61.
  • 29. Kralovics R, Passamonti F, Buser AS, Teo SS, Tiedt R, Passweg JR et al. A gain-of-function mutation of JAK2 in myeloproliferative disorders. N Engl J Med. 2005;352:1779-90.
  • 30. Beer PA, Campbell PJ, Scott LM, Bench AJ, Erber WN, Bareford D et al. MPL mutations in myeloproliferative disorders: analysis of the PT-1 cohort. Blood. 2008;112:141-9.
  • 31. Pardanani AD, Levine RL, Lasho T, Pikman Y, Mesa RA, Wadleigh M et al. MPL515 mutations in myeloproliferative and other myeloid disorders: a study of 1182 patients. Blood. 2006;108:3472-6.
  • 32. Antonioli E, Guglielmelli P, Poli G, Bogani C, Pancrazzi A, Longo G et al. Myeloproliferative Disorders Research Consortium (MPD-RC). Influence of JAK2V617F allele burden on phenotype in essential thrombocythemia. Haematologica. 2008;93:41-8.
  • 33. Vannucchi AM, Antonioli E, Guglielmelli P, Pancrazzi A, Guerini V, Barosi G et al. Characteristics and clinical correlates of MPL 515W>L/K mutation in essential thrombocythemia. Blood. 2008;112:844-7.
  • 34. Passamonti F, Rumi E, Arcaini L, Boveri E, Elena C, Pietra D et al. Prognostic factors for thrombosis, myelofibrosis, and leukemia in essential thrombocythemia: a study of 605 patients. Haematologica. 2008;93:1645-51.
  • 35. Kiladjian JJ, Rain JD, Bernard JF, Briere J, Chomienne C, Fenaux P. Long-term incidence of hematological evolution in three French prospective studies of hydroxyurea and pipobroman in polycythemia vera and essential thrombocythemia. Semin Thromb Hemost. 2006;32417-21.
  • 36. Dror Y, Blanchette VS. Essential thrombocythaemia in children. Br J Haematol. 1999;107:691-8.
  • 37. Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. Br J Haematol. 2005;129:165-77.
  • 38. Besses C, Cervantes F, Pereira A, Florensa L, Solé F, Hernández-Boluda JC et al. Major vascular complications in essential thrombocythemia: a study of the predictive factors in a series of 148 patients. Leukemia. 1999;13:150-4.
  • 39. van Genderen PJ, Michiels JJ. Erythromelalgia: a pathognomonic microvascular thrombotic complication in essential thrombocythemia and polycythemia vera. Semin Thromb Hemost. 1997;23:357-63.
  • 40. van Genderen PJ, Prins FJ, Michiels JJ, Schrör K. Thromboxane-dependent platelet activation in vivo precedes arterial thrombosis in thrombocythaemia: a rationale for the use of low-dose aspirin as an antithrombotic agent. Br J Haematol. 1999;104:438-41.
  • 41. Elliott MA, Tefferi A. Thrombosis and haemorrhage in polycythaemia vera and essential thrombocythaemia. Br J Haematol. 2005;128:275-90.
  • 42. Wolanskyj AP, Schwager SM, McClure RF, Larson DR, Tefferi A. Essential thrombocythemia beyond the first decade: life expectancy, long-term complication rates, and prognostic factors. Mayo Clin Proc. 2006;81:159-66.
  • 43. Bazzan M, Tamponi G, Schinco P, Vaccarino A, Foli C, Gallone G et al. Thrombosis-free survival and life expectancy in 187 consecutive patients with essential thrombocythemia. Ann Hematol. 1999;78:539-43.
  • 44. Carobbio A, Thiele J, Passamonti F, Rumi E, Ruggeri M, Rodeghiero F et al. Risk factors for arterial and venous thrombosis in WHO-defined essential thrombocythemia: an international study of 891 patients. Blood. 2011;117:5857-9.
  • 45. van Genderen PJ, Budde U, Michiels JJ, van Strik R, van Vliet HH. The reduction of large von Willebrand factor multimers in plasma in essential thrombocythaemia is related to the platelet count. Br J Haematol. 1996;93:962-5.
  • 46. Ruggeri M, Finazzi G, Tosetto A, Riva S, Rodeghiero F, Barbui T. No treatment for low-risk thrombocythaemia: results from a prospective study. Br J Haematol. 1998;103:772-7.
  • 47. Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995 Apr 27;332:1132-6.
  • 48. Finazzi G, Ruggeri M, Rodeghiero F, Barbui T. Efficacy and safety of long-term use of hydroxyurea in young patients with essential thrombocythemia and a high risk of thrombosis. Blood. 2003;101:3749.
  • 49. Storen EC, Tefferi A. Long-term use of anagrelide in young patients with essential thrombocythemia. Blood. 2001;97:863-6.
  • 50. Greist A. The role of blood component removal in essential and reactive thrombocytosis. Ther Apher. 2002;6:36-44.
Toplam 50 adet kaynakça vardır.

Ayrıntılar

Konular İç Hastalıkları
Bölüm Derleme
Yazarlar

Melike Sezgin Evim

Birol Baytan

Adalet Meral Güneş Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 15 Sayı: 3

Kaynak Göster

APA Sezgin Evim, M., Baytan, B., & Meral Güneş, A. (2017). TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM. Güncel Pediatri, 15(3), 44-48.
AMA Sezgin Evim M, Baytan B, Meral Güneş A. TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM. Güncel Pediatri. Aralık 2017;15(3):44-48.
Chicago Sezgin Evim, Melike, Birol Baytan, ve Adalet Meral Güneş. “TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM”. Güncel Pediatri 15, sy. 3 (Aralık 2017): 44-48.
EndNote Sezgin Evim M, Baytan B, Meral Güneş A (01 Aralık 2017) TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM. Güncel Pediatri 15 3 44–48.
IEEE M. Sezgin Evim, B. Baytan, ve A. Meral Güneş, “TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM”, Güncel Pediatri, c. 15, sy. 3, ss. 44–48, 2017.
ISNAD Sezgin Evim, Melike vd. “TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM”. Güncel Pediatri 15/3 (Aralık 2017), 44-48.
JAMA Sezgin Evim M, Baytan B, Meral Güneş A. TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM. Güncel Pediatri. 2017;15:44–48.
MLA Sezgin Evim, Melike vd. “TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM”. Güncel Pediatri, c. 15, sy. 3, 2017, ss. 44-48.
Vancouver Sezgin Evim M, Baytan B, Meral Güneş A. TROMBOSİTOZU OLAN ÇOCUĞA YAKLAŞIM. Güncel Pediatri. 2017;15(3):44-8.