Introduktion: Immunologisk trombocytopeni, ITP är en autoimmun sjukdom. Hos ITP patienter bildas autoantikroppar mot trombocyter som leder till trombocyt eliminering och därmed till trombocytopeni. ITP kan delas in i olika grupper beroende på durationen. Duration i mindre än tre månader kallas för nydiagnostiserad ITP, duration mellan 3 och 12 månader kallas för persistent ITP och duration i mer än 12 månader kallas för kronisk ITP. ITP kan behandlas med olika terapier som anti-CD20-antikroppar som rituximab och trombopoietin-receptor-agonister eltrombopag.  Syfte: Examensarbetes syfte är att undersöka samt jämföra effektivitet mellan rituximab och eltrombopag mot kronisk ITP patienter. Metod: Det här arbetet är baserat på en litteratursökning via databasen PubMed med sökord ”eltrombopag and immune thrombocytopenia” och ” rituximab and immune thrombocytopenia” och därefter valdes 4 Randomized Controlled Trial studier.  Resultat: Studie 1 visade bra effektivitet av rituximab mot kronisk ITP och 28% av patienter kunde nå trombocytantal över 50 x109/L i över 6 månader efter behandlingens slut. Studie 2 visade bra effektivitet av rituximab mot kronisk ITP och 30,8% av patienter kunde nå trombocytantal över 50 x109/L i över 6 månader efter behandlings slut. Studie 3 visade mycket bra effektivitet av eltrombopag mot kroniskt ITP och 60% av patienter kunde nå trombocytantal över 50 x109/L under behandlingstiden. Effekten försvann efter 2 veckor av behandlingens slut.  Studie 4 visade mycket bra effektivitet av eltrombopag mot kroniskt ITP och 59% av patienter kunde nå trombocytantal över 50 x109/L under behandlingstiden. Effekten försvann efter 2 veckor av behandlingens slut.  Slutsats: Både rituximab och eltrombopag visade bra effekt hos ITP patienter, men eltrombopag visade bättre effekt mot kronisk ITP än rituximab. Eltrombopag kunde ge bättre effektivitet samt snabbare svar på ökning av trombocytantalet hos de flesta patienter som behandlades i jämförelse med rituximab. Dock försvann effekten av eltrombopag snabbare efter utsatt behandling. / Introduction: Immunological thrombocytopenia, ITP is an autoimmune disease that can develop in our bodies. Autoantibodies develop in ITP patients against platelets, which are small cells without a nucleus and are formed from the megakaryocytes and play an important role in hemostasis and blood clotting. This leads to platelet elimination and thus to thrombocytopenia. Thrombocytopenia is a condition that means low levels of platelets in the individual and which can lead to various severe symptoms such as bleeding and can even cause death. The cause of ITP may be unknown and then it is called primary ITP. Other reasons can be such as acquired immune deficiency syndrome (AIDS) and then the immune system against platelets is triggered, this is called secondary ITP. ITP can also be divided into different groups depending on the duration in each patient. Duration of less than three months is called newly diagnosed ITP, duration between 3 and 12 months is called persistent ITP and duration of more than 12 months is called chronic ITP. ITP can be treated with various therapies. First line therapy is glucocorticoids, and second line therapy is splenectomy, anti-CD20 antibodies rituximab and thrombopoietin receptor agonists such as eltrombopag. Aim: The purpose of the study is to investigate and compare the efficacy of rituximab and eltrombopag patients with chronic ITP. Method: This work is based on a literature search via the database PubMed with the keywords "eltrombopag and immune thrombocytopenia" and "rituximab and immune thrombocytopenia" and then 4 Randomized Controlled Trial studies were selected, 2 studies deal with rituximab and 2 studies deal with eltrombopag. Results: Study 1 showed good efficacy of rituximab compared to placebo against chronic ITP and 28% of patients were able to reach platelet counts above 50 x109/L for more than 6 months after cessation of treatment. Study 2 showed good efficacy of rituximab in chronic ITP and 30.8% of patients were able to reach platelet counts above 50 x109/L for more than 6 months after treatment. Study 3 showed very good efficacy of eltrombopag against chronic ITP and 60% of patients were able to reach platelet counts above 50 x109/L during the treatment period. The effect disappeared after 2 weeks of treatment discontinuation. Study 4 showed very good efficacy of eltrombopag against chronic ITP and 59% of patients were able to reach platelet counts above 50 x109/L during the treatment period. The effect disappeared after 2 weeks of treatment discontinuation. Conclusion: Both rituximab and eltrombopag showed good efficacy against ITP patients, but eltrombopag showed better efficacy against chronic ITP than rituximab. The NNT number showed that more patients need to be treated with rituximab compared to eltrombopag in order for only one of the patients to be able to achieve a platelet count above 50 x109/L, which means a greater chance for those treated with eltrombopag to achieve a platelet count above 50 x109/L. Eltrombopag was able to provide better efficacy and a faster response to increase in platelet count in most patients treated compared to rituximab.

Glykerat hemoglobin, HbA1c, är en indikation på genomsnittligt glukosvärde. HbA1c används vid diagnostisering av diabetes men också uppföljning av diagnostiserade diabetiker. Uppföljningen visar hur väl diabetiker förhåller sig till kost men också medicinering. Informationen av patientens HbA1c värde spelar en stor roll i vidare behandlingar. Analysmetoden HbA1c är inte helt standardiserad vilket har medfört att flera analysmetoder utvecklats för HbA1c. Syftet med denna studie var att undersöka om en enzymatisk, Direct enzymatic HbA1c eller immunologisk analysmetod, Hemoglobin A1c kan lösa problemet med hemoglobin-variationer vid analys av HbA1c som idag analyseras med HPLC som rutin på klinisk kemi-laboratorium i Västerås. Genomförandet gjordes på två instrument, TOSOH G7 och AU 680. TOSOH:s värden (HPLC) användes vid jämförelse av de två analysmetoderna på AU680. Förberedelse och behandling, såsom hemolysering, skedde innan proven sattes i instrumentet AU680. Resultatet (n=134) visade att analysmetoden Hemoglobin A1c förhöll sig väl till HPLC analysmetod (R 2=0,98) jämfört med vad analysmetoden Direct enzymatic HbA1c gjorde (R2=0,86). Likartade resultat kunde observeras för Hemoglobin A1c (R2=0,98) och Direct enzymatic Hba1c (R2=0,95) då bara patientprov med hemoglobin-varianter analyserades (n=10). Mann-Whitney’s U-test vid analys av hemoglobin varianter med Hemoglobin A1c visade en tendens till signifikant skillnad gentemot HPLC analysen (p=0,051; n=34). Fel reagens erhölls från reagenstillverkaren gällande Direct enzymatic, Detta kan förklara det erhållna resultatet och kräver fler analyser med korrekta reagens. Hemoglobin A1c bör även undersökas vidare med mer omfattande provmaterial för möjlig standardisering i rutin hos KKTM i Västerås. / Glycated hemoglobin, HbA1c, is an indication of average long-term glucose. HbA1c is used as a diagnostic method for diabetes but also as a follow-up for diagnosed diabetics. Follow-ups shows how well a diabetic relates to diet but also medication. The information of the patient's HbA1c value plays an important factor in further treatments. The analysis method for HbA1c is not standardized, which has resulted in several analysis methods developed for HbA1c. The purposes of this study were to investigate whether an enzymatic, Direct enzymatic HbA1c or immunological assay method, Hemoglobin A1c, can solve the problem of hemoglobin variations in the analysis of HbA1c, which is currently analyzed by HPLC as a routine at the clinical chemistry laboratory in Västerås The implementation was performed on two instruments, TOSOH G7 and AU 680. The values from TOSOH (HPLC) were used for comparison of the two analysis methods applied on the AU680. Preparation and treatment, such as hemolysis, occurred before putting the samples into the AU680 instrument. The result showed that the Hemoglobin A1c assay method was well-matched with HPLC assay (R2 = 0.98) in comparison to that of the Direct enzymatic HbA1c assay method (R2 = 0.86). Similar results could be observed for Hemoglobin A1c (R2 = 0.98) and Direct Enzyme HbA1c (R2 = 0.95) when only samples from patients with hemoglobin variants were analyzed (n=10). Solely analysis of hemoglobin variants with Hemoglobin A1c showed a boundary case for a significant difference compared to HPLC analysis (P = 0.051; n=134). Incorrect reagents were obtained from the reagent manufacturer in the case of Direct enzymatic. This can explain the results obtained. Hemoglobin A1c should also be investigated with more extensive test materials for possible standardization in the routine of KKTM in Västerås.