صادق صداقت

Splenectomy considered as second line therapy in management of patients with idiopathic thrombocytopenic purpura (ITP) whom did not respond to corticosteroid or the platelet decreased after corticosteroid cessation. The aim of the present study was to determine the response to splenectomy in chronic ITP patients. This retrospective cohort study was performed on all patients with ITP who underwent splenectomy at Shahid Beheshti and Yahyanejad hospitals during 10 years. Age، sex، time of initial treatment، time of surgery، platelet counts at time of diagnosis، pre- and post-operative platelet counts، respond to treatment and receiving treatment، extracted from the patient''s registry. From 41 patients، the immediate postoperative response was partial in 4 patients (9. 8%) and complete in 37 patients (90. 2%). Non-response was not seen in any patient. The median follow-up was 12 months (range: 1-101 months). In long-term follow up، complete response (CR) was achieved in 4 patients (85. 3%) and partial response was achieved in 2 (%4. 9) of patients and treatment failure was achieved in 4 patients (9. 8%). According to the results of this study، many of patients with ITP who underwent splenectomy have long term remission and splenectomy is a safe and effective method of treatment for these patients.

Background and Thrombocytopenia is the most common disorder in pregnancy after anemia, and occurs in 10 percent of pregnancies. Thrombocytopenia in pregnant women may be associated with maternal and neonatal morbidity. Because of the diagnosis of thrombocytopenia is effective in patient's treatment and according to its complications in pregnancy, this study was performed to determine the incidence, causes and complications of thrombocytopenia in pregnancy. In this prospective study, all pregnant women with gestational age of 24< weeks and referred for termination of pregnancy to shahid yahyanejad and Ayatollah Rohani hospitals in Babol, selected and women who had the tests in microliters platelets less than 150,000 per microliters were enrolled. Cause of thrombocytopenia, method of delivery, maternal and neonatal complications in these patients collected were recorded. Platelet count less than 100,000 in microliters as severe thrombocytopenia was considered. Then enter the data and statistical software SPSS 18 cases were analyzed. During the study period, 4589 pregnancies were examined, of which thrombocytopenia was reported in 239 pregnancies and the incidence of thrombocytopenia in pregnancy was 5.2%. Cause of thrombocytopenia were in 222 patients (%92.9) thrombocytopenia of pregnancy, in 11 patients (% 4.6) ITP, 5 patients (half percent) of preeclampsia and one patient (% 0.4) had HELLP syndrome. 6 pregnancies (2.5 %) was associated with IUFD. maternal complications occurred only in one patients with ITP, that It was bleeding during and after of delivery. No neonatal complications occurred in newborns of women with thrombocytopenia. The results of this study, gestational thrombocytopenia, the most common cause of thrombocytopenia in pregnancy and are considering this cause complications for the patient and the fetus did not have, but these diagnose should be differenthied from other diagnosis such as Hellp syndrome or preeclampsia that these need the urgency termination of pregnancy for prevension of complication.

Alpha thalassemia is one of the most common hemoglobin disorders. Some combination of alpha globin gene mutations may cause HbH disease with severe anemia or intermediate thalassemia. genotype common deletions are routinely tested for suspicious alpha thalassemia couples but because of lack of information about the nature and frequency of point mutations and higher expenosor of sequencing, less attention was paid to them. This study was done to determine the prevalence of common point mutations of alpha globin gene in Babol, Iran. This descriptive study was carried out on DNA of 153 adult suspected to α-thalasemia with deleted α- golobolin gene referred to genetic laboratory in Babol, Iran during 2005-09. a1 and a2 genes were amplified by using specific biotinilated primers by PCR method. PCR products were assayed using 11 specific probs corresponding to common point mutations in alpha gene (C19, IVSI (-5nt), C59, Hb constant spring, Hb Icaria, Hb seal Rock, IVSI (148), C14, poly A (-2bp), poly A2, Poly A1) and fixed on byodine C membrabe. Hybridization between the probes and PCR products was visualized after a colorimetric reaction using of conjugated streptavidin peroxidase and TMB (tetra methyle Benzidine) and H2O2. The prevalence of point mutations in poly A2, 5nt, Hb constant spring and poly A1 were 28.75%, 14.38%, 7.84% and 2.61%, respectively. Point mutation in alpha globin genes was detected in %53.60 out of 153 adults suspected with alpha thalassemia without common deletion mutations.