Overview
Platelets consist of small cell cytoplasms deprived sound base. They are the smallest blood and particles are formed by the removal of fragments from the parent cell that is located in the bone marrow. platelet life cycle is 8 to 12 days and ends in the spleen where obsolete fragments absorbed by tissue cells and place them in the bloodstream replaced by new platelets.
Platelets have a number of essential body functions:
- In view of the ability of platelets to the elimination of alien elements in inflammatory processes, they help the body cope with the problem.
- The outer surface of blood platelets is composed of specific molecules able to determine the damaged area on the vessels. Thus, platelet closes an injured portion of the capillary, serving as a patch. When changing the formation of blood platelets in the blood flow line having small but multiple kroizliyaniya.
- However, the main function of platelets is given the ability to fast hemostasis - red plates form a platelet plug, uzhimaniyu vessels and contribute to their actions activates the blood coagulation system, through which the maturation protein clot.
When pronounced thrombocytopenia human life is in danger because of the impossibility of stopping the bleeding.
Causes
Physiological characteristics of the structure and the formation of blood platelets to fully determine the reasons for the birth of thrombocytopenia.
There are three main areas of previous pathology:
thrombocytopenia products
This term means that the bone marrow decreased formation of blood platelets. The process of reduction of platelet formation associated with a group causes.
The lack of cell growth in the bone marrow, where the platelets progenitor replaced not at full strength. This process is facilitated by:
- aplastic anemia;
- intake of drugs (cytostatics, chloramphenicol, antithyroid agents);
- alcohol abuse;
- viral infections, including those with injections of live vaccine (cases were noted where the lack of cell growth was caused by the vaccine against measles, mumps, hepatitis A, B, C);
- fungal and bacterial diseases (most often given reason causes complications in children);
- human immunodeficiency (eg, HIV-infected individuals);
- prolonged anoxia.
Inefficient trombotsitopoz at which the inhibition of formation of new platelets due to:
- Deficiency substance that activates the formation of blood plates;
- beriberi (especially with the lack of folic acid and vitamin B12);
- iron deficiency anemia;
- alcohol intoxication;
- complex congenital diseases;
- viral infections.
Metaplasia cell growth in which there is degeneration (substitution) platelet cell growth in bone marrow, the cause of which are:
- metastases in the bone marrow in the last stages of cancer;
- Oncology of the circulatory system (myeloma, leukosisLymphoma);
- sarcoidosis;
- myelofibrosis.
thrombocytopenia destruction
Galloping destruction of blood platelets - one of the most frequent causes of disease. The process inevitably results in the proliferation of the bone marrow, increased levels of cell and platelet counts.
Classify the two forms of thrombocytopenia destruction - immunological and non-immunological.
Immunological diseases Group is divided into three types:
- Isoimmune - when the body penetrate "foreign" platelets (mostly blood transfusion), there is the production of alloantibodies.
- Autoimmune - seen against the background of premature dying of blood platelets as a result of the pathological action of antibodies (Observed with rubella, HIV, systemic lupus erythematosus, rheumatoid arthritis, with the passage, lymphoma and other autoimmune diseases).
- Immune - unnatural reaction provoked, mainly medicines, which list is very large (penicillin group, aspirin, heparin, furosemideMorphine, cimetidine, Biseptol and many others).
Causes non-immune destruction of the mechanism of thrombocytopenia associated with changes in blood vessels and can be observed:
- a heart defects;
- in the postoperative period cardiac organ (grafting, implantation of artificial valve);
- at atherosclerosis;
- at oncological diseases where blood vessels are affected metastases.
thrombocytopenia redistribution
In the normal state is fixed up to 45% vigorous platelets in the spleen. When a platelet deficiency, blood leaving the plate body limits and enter the bloodstream. If, on the contrary, there are delayed platelets, observed their early destruction.
This process usually occurs in liver cirrhosis, cancer and the associated infection (malaria, endocarditis, tuberculosis).
symptoms
The cause of the disease does not appear on the symptoms of thrombocytopenia. Reduction of platelet formation has the following features:
- bleeding gums (it is important not to confuse with scurvy and other problems of the mouth);
- gastrointestinal bleeding;
- predisposition to bruising;
- copious during menstruation;
- hemorrhage into the body cavity.
severity
Severity of disease symptoms is completely predetermined level of reduction of blood platelets.
mild
If the concentration of platelets in the blood channel exceeding the boundary indicators 30 000 - 50 000 l, the disease is concealed. Permissible infrequent bleeding from the nose. For minor violations integrity of the skin appear slight bruising, increased durability and profuse discharge during the critical days in women.
At the initial stage, and rarely diagnosed pathology largely in the survey for the presence of completely different diseases.
The degree of average weight
Disease with rates from 20 000 to 50 000 MLK is characterized by a specific manifestation of hemorrhagic rash. Visually it looks as multiple small bruises on the skin and mucosal surfaces.
severe
When a drop of platelets in the blood crosses below the mark of 20 000 l, the complications are not forced to wait - there bleeding in the gastrointestinal tract and bleeding in the abdominal organs.
current forms of thrombocytopenia
There are two forms of current illness - acute and chronic. First more character for children ages 2 to 6 years or for the period of adolescent hormonal changes. Chronic form affects adults.
The acute form
It lasts up to six months, and more often in postvirusny during or after vaccination. Children of both sexes are equally prone to this ailment, although the girls during hormonal changes thrombocytopenia is more common.
Typical manifestations of the disease in children include:
- bleeding from the wound after tooth extraction, as well as nasal and uterine (girls);
- tarry stool stool;
- blood clots in the urine;
- splenomegaly;
- rash on the mucosal surfaces of the oral cavity;
- bleeding in the retina.
Each of these symptoms of thrombocytopenia in the absence of adequate treatment can have consequences in the form of posthemorrhagic anemia, hemorrhage into the brain or viscera. If timely action taken - forecasts are favorable.
The chronic form
It develops in adults, usually female, aged from 20 to 40 years old. The disease does not occur immediately, it is very difficult to determine its cause. Most often thrombocytopenia in adults is associated with viral infections undertreated and toxic poisoning.
Symptomatology of the chronic form of the disease is expressed by the following features:
- cutaneous hemorrhage (from point to single bruises);
- vomiting blood or hemoptysis;
- stool mixed with blood;
- haemorrhages in the mucous (mouth and conjunctiva) - predecessors complications such as bleeding in the brain.
Special attention should be paid to thrombocytopenia in pregnancy. Pathology occurs in the third trimester in 10% of women. And, if the causes of thrombocytopenia are immune in nature, it can threaten the future complications child as antibodies, penetrating through the placental protection, cause the destruction of platelets in the fetus.
Diagnostics
For thrombocytopenia as an independent disease often has pronounced symptoms and so easily diagnosed. But in any case it is necessary to pass a complete blood count: this will help determine the level of platelet count and establish the diagnosis.
To determine the secondary thrombocytopenia required supporting studies:
- sample to the immunological response of an organism;
- bone marrow puncture;
- careful study of history.
Control measures are needed in severe pathologies, especially cancer, liver cirrhosis or systemic connective tissue diseases.
Treatment
Treatment of thrombocytopenia in children based on expectant management. When the flat course of the disease medical therapy is not needed, and platelet count alone is aligned over the six months.
If the disease has changed its course, increases the hemorrhagic syndrome and the risk of changes in intracranial blood flow, applies urgent steroid therapy (prednisolone). The results of treatment are visible already in the first week, the symptoms reduced, equalized level of blood platelets.
In adults in chronic thrombocytopenia independent recovery happens very rarely. thrombocytopenia treatment starts with a decision prednisolone within one month. Unless there is complete or partial remission, the platelet level drops, and hemorrhagic syndrome persists prescribe immunotherapy.
For suppression of antibody production is conducted intravenous immunoglobulin therapy in combination with steroids in high doses. If after three months (sometimes six months) is not positive, prescribe surgery to remove the spleen - splenectomy. As a rule, immediately after surgery platelet counts to normal.
When acting as thrombocytopenia accompanying other disease states, in the first place, it is treated. If the platelet count is maintained at a critical point, and the symptoms is pronounced, also used the course prednisolone or a blood transfusion.
power Features
Strict diet is impossible for thrombocytopenia, because the body needs a full supply of various nutrients, especially protein. Therefore, the total vegetarianism is excluded, but the meat to the vegetables better to choose lean, with no fat layers.
In the acute phase should avoid hot, spicy, fatty and smoked foods, so as not to irritate the stomach and not to provoke bleeding. Absolutely contraindicated alcohol and products with dyes and flavor enhancers (chips, nuts, soda, etc.), since they inhibit the production of platelets.
Forecast
In childhood, complete recovery occurs in 80% of cases, as with the therapy, and without it. But 20% of patients who have infrequent periods of remission are observed, can not be cured completely.
Adult patients with chronic disease must constantly monitor the state of his health, as any "provocation" - infectious, drug, toxic, reduces platelet levels can cause complications.
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