Thrombocytopenia - symptoms and treatment
Thrombocytopenia is a common name for diseases that are characterized by a decrease in the number of platelets in the blood. Normally, this value is 180-400 * 10 9 / l. If the platelet level decreases significantly, then a person will experience nosebleeds, women suffer from prolonged menstruation, which are accompanied by abundant blood flow. Also, thrombocytopenia is indicated by bleeding gums, subcutaneous and internal hemorrhages.
Content:
- What are platelets in the body responsible for?
- Pathogenesis of thrombocytopenia
- Types of thrombocytopenia
- Thrombocytopenic purpura
- Thrombocytopenia symptoms
- Thrombocytopenia in childhood and pregnancy
- How to detect thrombocytopenia?
- Thrombocytopenia treatment
What are platelets in the body responsible for?
The place of platelet production is the bone marrow. They are made from large megakaryocytes. Platelets are shaped like plates, oval or round in shape. The diameter of the blood cells is 2-4 microns. Platelets can change the shape of a circle to a spherical shape, forming outgrowths on their outer membrane, which is possible due to the presence of receptors on their surface, which are based on glycoprotein complexes. These outgrowths connect with each other and with the vascular walls in the place where they are damaged. Fibrin strands allow platelets to attach to existing defects, after which these blood cells begin to secrete an enzyme called thrombostenin. Under its influence, the threads twist and become denser.
Also platelets produce enzymes responsible for normal blood clotting, as well as platelet fibrinogen, platelet growth factor, peroxidase, serotonin, immune complexes and other substances that play an important role in the normal functioning of the body.
So, platelets are necessary for a person to ensure his life, since they take part in many important processes, including:
- The formation of a blood clot, which is necessary to stop bleeding at the site of damage to small vessels.
- Maintenance of vascular spasm.
- Vascular wall nutrition.
- Development of immune complexes.
- Dissolving blood clots.
Platelet counts over a 24-hour period can fluctuate by no more than 10% of the normal level. If a woman is menstruating, then these fluctuations are from 20 to 50%. Therefore, when the diagnosis of thrombocytopenia is made, it is necessary that the platelet count is less than 100 * 10 9 / l.
80% of people with low blood platelets have nosebleeds. Also, pathology is indicated by prolonged menstruation, increased bleeding of the gums.
A new platelet, on average, lasts no more than 10 days. After that, it becomes smaller. If the platelets are less than 7.0 fl, then the person has either recently had a spleen removed or suffers from Wiskott-Aldrich syndrome. This disease is accompanied not only by thrombocytopenia, but also by immunodeficiency and cutaneous eczema. Therefore, during laboratory diagnostics, it is necessary to take into account the average size of the platelets. This indicator is referred to in the test results as MPV. Its normal values are 7.4-10.4 fl.
Pathogenesis of thrombocytopenia
The drop in platelets in the blood occurs for the following reasons:
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Drop in the level of megakaryocytes, or their complete disappearance. Megakaryocytes can stop being synthesized by the body in the case when a person develops pathologies of the blood, thyroid gland, and liver. The abuse of alcoholic beverages, the intake of toxic substances, the transferred viral infections, the intake of antibacterial drugs, the radiation exposure of the body, the lack of vitamin B12 and folic acid are negatively reflected in their numbers. Low megakaryocyte counts are seen in people who are receiving HIV therapy or who develop HIV-associated infections.
- Increased destruction of platelets. The reasons why platelets are destroyed at a high rate are very diverse, among them: Verlhof's disease, disseminated intravascular coagulation syndrome, previous blood transfusion, therapy with antihistamines, sulfonamides, etc.
- Failure in the distribution of platelets. If a person does not have any pathologies in the body, then about 45% of all platelets are in the spleen. If somewhere there is an increased need for these blood elements, then the stock is taken from this depot. Provided that a person suffers from tuberculosis, hepatitis, malaria, or blood disease, the platelet count in the spleen can rise up to 90%. This will lead to the fact that they begin to become smaller and break down faster.
So, thrombocytopenia is often a consequence of the effects on the body of drugs, but it can be both a symptom of hereditary pathologies, and a sign of many diseases acquired during life.
Types of thrombocytopenia
Thrombocytopenia can be a congenital or acquired pathology. Congenital diseases include Wiskott's syndrome, Fanconi's syndrome, giant platelet syndrome, etc.
However, most often thrombocytopenia is a consequence of acquired diseases, or rather, reduced immunity against their background.
In this regard, the following types of thrombocytopenia are distinguished:
- Isoimmune, which develops due to the incompatibility of the blood groups of the mother and the fetus.
- Transimmune, when the autoantibodies of a mother suffering from autoimmune thrombocytopenia are passed on to the fetus.
- Heteroimmune, which develops when platelets are damaged by a pathogenic agent, after which the body begins to produce antibodies against them.
- Autoimmune, when the body recognizes its own platelets as foreign substances and begins to destroy them. This condition can accompany cancer, autoimmune processes, HIV, herpes infection, rubella, and can develop while taking medication.
Thrombocytopenic purpura
Purpura, associated with low blood platelet counts, can result from hepatitis, systemic lupus erythematosus, lymphoma, and other conditions. If the cause of purpura remains unclear, then we can talk about the idiopathic nature of the disease.
Werlhof's disease is a chronic form of thrombocytopenic purpura. In 5% of cases, the pathology ends in death, which is caused by a hemorrhagic stroke, or opened internal bleeding. The vast majority of patients with this diagnosis are young women. In childhood, idiopathic thrombocytopenia develops acutely, but in 75% of cases it ends well, that is, a full recovery.
Thrombocytopenia symptoms
The symptoms of thrombocytopenia are as follows:
- On the human body, multiple subcutaneous hemorrhages are found, which can be presented both in the form of small dots and in the form of large hematomas. Moreover, they are formed even with a slight blow or other physical impact.
- The rash may be blue, brown, green, or yellowish in color. This indicates that they did not appear at the same time, but at different times (some are passing, others are quite fresh).
- Hemorrhages are located on the arms and legs, on the abdomen, on the face, in the mouth, on the chest.
- A person notices increased bleeding of the gums, he is worried about nosebleeds, which occur quite often.
- In women, prolonged periods are observed, and bleeding from the vagina occurs in the intervals between cycles.
- Against the background of thrombocytopenia, bleeding after surgery is a danger to human life. Moreover, it is not necessary that the intervention will be global. We are even talking about the extraction of teeth, or overgrown tissue of the tonsils.
- Hemorrhages often occur in the eyeball as well.
- Bleeding of internal organs, including the brain, may develop.
- Sometimes a symptom of thrombocytopenia is an enlargement of the spleen.
The symptoms of thrombocytopenia are explained not only by the fact that the blood loses its ability to clot, but also by the fact that the permeability of the vascular wall increases. The blood cannot clot due to the fact that the production of an enzyme is disrupted, which is responsible for the adhesion of platelets to the vascular wall, as well as for their normal size. Vessels lose their normal permeability due to the fact that the processes of their nutrition, for which platelets are responsible, are disrupted. The effect is exerted by a low level of serotonin, which is also produced by platelets and regulates the normal contractions of the vascular wall.
Thrombocytopenia in childhood and pregnancy
Women who are carrying a fetus rarely encounter an acute form of the disease with a severe course. However, thrombocytopenia increases the risk of miscarriage in the first six months of pregnancy. In its second half, the threat of early onset of labor, as well as the development of severe bleeding during childbirth, increases.
Sometimes, during pregnancy, a woman recovers from thrombocytopenia. Nevertheless, in the chronic form of the disease with frequent exacerbations, doctors recommend refusing to continue the family.
Pathology is rare in children, from 3 to 5 babies are ill per 100,000 people. The main sign of the disease in childhood is small subcutaneous hemorrhage.
How to detect thrombocytopenia?
The doctor may suspect a pathology on the basis of examination of the patient and collection of anamnesis.
To confirm the diagnosis, blood donation will be required:
- The level of platelets is low, or they are absent in the blood at all.
- The platelet size is reduced.
- The blood taken from the vein will clot after 6 hours. It can sometimes remain loose for several days.
- Antibodies to platelets are found in the blood.
- The granularity of platelets is reduced.
- Platelets have different colors and shapes.
- The patient is diagnosed with anemia and leukopenia.
When taking a puncture of the bone marrow, multiple megakaryocytes without granules, with vacuoles were found. Cells grow unevenly. When the disease recurs, the number of megakaryocytes decreases.
Thrombocytopenia treatment
If the patient develops massive bleeding, then he needs a transfusion of plasma and blood with an increased platelet count. However, care must be taken to prevent the formation of antiplatelet antibodies in the patient's own blood. If the transfusion is not stopped in time, the bleeding will only intensify.
To stop blood loss, the patient is injected with sodium ethamsylate, epsilon-aminocaproic acid, a hemostatic sponge, thrombin, serotonin adaptin, calcium chloride in a solution of B vitamins, and iron preparations. If bleeding increases, then transfusion of plasma and red blood cells is indicated.
If thrombocytopenia is provoked by autoimmune processes, then the patient is shown systemic administration of corticosteroids. As bleeding decreases, the dosage of hormonal drugs is reduced. Treatment with glucocorticosteroids can last 1-3 months.
If it is not possible to cope with the pathology with the help of medical correction, and the disease recurs, then the removal of the spleen is required. The efficiency of the operation is equal to 80%. Platelets cease to undergo massive decay, which leads to recovery.
If none of the methods allows you to achieve a result, then the patient is prescribed immunosuppressants. However, these drugs adversely affect immunity and the function of hematopoiesis.
The prognosis for recovery from thrombocytopenic purpura is most often favorable.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
