Thrombocytopenia - a pathology associated with a sharp drop in the number of red blood cells or platelets.Platelets have a huge impact on the mechanism of blood clotting, which is why the lack of them can cause bleeding or sudden bleeding into the cavity of the internal organs, which is a direct threat to human health and life.
essence of the morphology of platelets is that they lack the core and they are areas of megakaryocyte cytoplasm.Their formation occurs in the bone marrow in a process of disconnecting fragments maternal cells.Living platelets not more than 12 days.Dead platelets digest macrophages in the tissues of the body, and instead of bone marrow mature young.The cell wall is represented by a membrane containing a special type of molecules whose function is in recognition of the damaged segments of arteries and veins.Even capillary bleeding starts the blockage lesion platelets, by inserting so-called "patches" in the wound cavity vessel.On this basis, the main
Physiological characteristics in the life cycle of red blood platelets allow us to classify the factors leading to thrombocytopenia on:
- reduces the formation of platelets;
- increasing destruction of blood platelets;
- leading to a redistribution of platelets.
first factor, in turn, are divided into: trombotsitoneniyu induced megakaryocytic hypoplasia of the germ, thrombocytopenia, caused by the inefficiency thrombocytopoiesis and thrombocytopenia as a result of replacing a germ of megakaryocytes in the epiphysis of long bones, at the site of the bone marrow.
Underdevelopment megakaryocytic germ occurs as a consequence of the inability of the brain to start the process of inert daily replacement.The reason appears as aplastic anemia, leading to hypoplasia of total leukocytes, platelets and red blood cells.
not the last role in the development of this type of thrombocytopenia playing antibiotics, cytostatics, anti-thyroid drugs and drugs of gold.So a group of cytostatics depressing effect on the bone marrow, and antibiotics lead to increased susceptibility to bone marrow of this group of drugs.Hypoplasia cause as alcohol, viral infection, routine vaccination against measles, sepsis patients, prolonged oxygen starvation of tissues and organs of the human body of various etiologies and others.There are cases and congenital hypoplasia, as an example - a constitutional aplastic anemia.
Thrombocytopenia induced inhibition thrombocytopoiesis process, caused by many reasons.One of them - this is an insufficient number of thrombopoietin, usually manifested at birth.Thrombopoietin - a substance which enhances the maturation of platelets from megakaryocytic germ.Currently, this pathology is diagnosed well, and lends itself to a rapid recovery.
Another factor disturbing the formation of platelets, is a severe iron deficiency anemia.This is because for maintaining normal levels of platelets in the blood system and cyanocobalamin or vitamin B 12, need a certain amount of iron.In addition, the reduction processes thrombocytopoiesis often associated with viral infection, alcohol intoxication and hereditary diseases, the etiology of which is unsuitable for high-quality ripening process of hematopoiesis platelets.
megakaryocytes to the replacement of bone marrow result: blood cancer with metastasis in its final stage, the proliferation of fibrous tissue and granulomas, substituting normal cells of the bone marrow cells of their own.These pathological conditions cause a reduction in the quantitative content of all formed elements in the blood, including platelets.
Factors that increase the destruction of platelets can be roughly classified on the immunological and immunological.This is the most extensive group of causes of thrombocytopenia, as the rapid dissolution of the blood platelets leads to an increase in the content of the structural elements of the circulatory system as a result of uncontrolled growths.
conventional groups immunological factors can be divided into:
- a product called aploantitel or isoimmune thrombocytopenia;
- a product called autoantibodies or autoimmune thrombocytopenia;
- caused by the appointment of drugs or immune thrombocytopenia.
isoimmune thrombocytopenia occurs as a consequence of entering into the bloodstream unusual for this body platelet.The reason for this is aploimmunnaya thrombocytopenic purpura newborns and resistance in blood transfusion recipients.Purpura newborn develops when platelet antigens incompatible mother to baby platelet antigens, resulting in the child's body fall to its alien blood system antibodies that destroy platelets.This disease is not common and is directly dependent on the immune status of women during pregnancy.The reasons for the resistance of the recipients have been little studied, but it is safe to say that their symptoms have a connection to incompatible blood transfusion in terms of blood platelets.
Autoimmune thrombocytopenia occurs when platelet destruction due to the influence of antibodies on immune complexes.This result of chronic lymphocytic leukemia, inflammatory diseases of the gastrointestinal tract, human immunodeficiency virus and others.
to factors that lead to the progression of immune thrombocytopenia, include antibiotics group penicillin, sulfonamides, heroin, morphine and other drugs, the purpose of anti-ulcer drugs such as cimetidine or ranitidine.Abolition of the drug on the insistence of the doctor, the patient is self-limiting.
reasons not related to immunity - a disease such as defects of the cardiovascular system, the body's blood vessels in metastases, replacement of valvular heart disease and narrowing of the arteries of atherosclerotic plaque.Massive bleeding and transfusion infusion of large amounts of drugs are also included in this group of factors.
When disturbed redistribution of platelets in the custody of such a body as the spleen, accumulates more than the number of platelets than normal.This results in splenomegaly.For diseases caused by the disease process include: liver cancer, leukemia, lymphoma, infectious respiratory diseases and others.
disease appears unexpectedly and in some cases prone to exacerbations, while others have a prolonged duration.Classify on geteroimmunnuyu thrombocytopenia and autoimmune form.The first form occurs acutely, and the second becomes chronic pathology.But this division is considered to be conditional, as the manifestation of clinical disease can not always relate to a specific form of thrombocytopenia.
thrombocytopenia begins with characteristic cutaneous hemorrhage and bleeding in the mucous membranes.Picture dermal hemorrhage occurs most often in the limbs and trunk.Sometimes they grab the border of the lips and face and meet in the place of injection.
bleeding after tooth extraction is rarely, begins immediately after removing it and its duration from a few hours to several days.If a stop is not inclined to relapse.
Such clinical sign is pronounced splenomegaly in patients with concomitant diseases.They include autoimmune hemolytic anemia, lymphocytic leukemia, chronic hepatitis.Liver thrombocytopenia is not increased, and in a small number of patients, usually inflamed cervical lymph nodes, leading to an increase in body temperature to subfebrile figures.Joining clinic artralgicheskogo syndrome and increase in the erythrocyte sedimentation rate suggests the presence of patients with systemic connective tissue diseases such as lupus.
general analysis of peripheral blood from the norm by the presence of reducing quantitative indicator of platelets.Plasma coagulation factors thus remain within acceptable numbers.The morphology of the platelets varies, they increase in size, there are blue cells observed their transformation.Increased number of reticulocytes and red blood cells are destroyed.Sometimes there is a shift of leukocyte formula to the left.In most cases the number of megakaryocytes thrombocytopenia bone marrow above normal due to extensive bleeding.Blood clotting time is lengthened, the response is positive capillary fragility, reducing blood clot decreases.
In clinical symptoms distinguish the following degrees of thrombocytopenia: mild, moderate and severe.
Mild thrombocytopenia occurs as a result of prolonged and heavy menstrual women, with nosebleeds and intradermal hemorrhages.At this stage, it is practically impossible to diagnose the disease, she accidentally revealed during a routine examination or because of a blood test checks to see a doctor about a different disease.
average degree of thrombocytopenia appears hemorrhagic rash that looks like many petechial hemorrhages on the skin and mucous membranes.
serious gastrointestinal bleeding cause severe thrombocytopenia, which occurs with a decrease in the index of platelets to 25,000 / microliter.
It should be noted that there is a secondary thrombocytopenia, as a type of the disease.Her clinic repeats clinic comorbidities.For example, allergic thrombocytopenia, as the result of allergic platelet antigens, resulting in damage or complete dissolution.
Thrombocytopenia in pregnancy
noticed that the number of platelets during pregnancy varies irregularly, because of great importance here is the individual state of the woman's body.If a pregnant woman is healthy, you may experience a slight decrease in platelet counts.This is due to a decrease in the period of their life, and their increased participation in the process of peripheral circulation.At low rates of platelets appear preconditions for the development of thrombocytopenia.The reason for this is the reduction in the formation of platelets, high degree of loss or consumption.Clinically, the disease is pronounced bleeding and bruising.Factors platelet deficiency are inadequate nutrition of pregnant women, immune disorders etiology or chronic blood loss.Thus, platelets are not produced, or acquire an irregular shape.
For the diagnosis of thrombocytopenia conduct research on blood coagulation in a coagulation.It is very informative and accurate method.The importance of obtaining information about platelets in the blood is that it makes it possible to prevent serious complications during childbirth.So the kid with immune thrombocytopenia in nature childbirth great development of internal bleeding, the most serious of which is a cerebral hemorrhage.In this scenario, the attending physician decides delivery surgically.In most cases, the disease does not threaten the health of the baby.
Statistics show that the number of children who develop thrombocytopenia among healthy children is 1 in 20,000 cases.In the main risk group includes preschool, the maximum number of TB cases is observed in winter and spring.
most commonly thrombocytopenia is innate.Such children often have an accelerated function of the spleen, or hypersplenism.This is possible because of the physiological characteristics of the organ.Spleen - a depot for the end of their term of platelets, where they die and are reborn.In addition, thrombocytopenia in neonates is at the immunological conflict due to lack of compatibility of the child and a pregnant woman on the platelet antigens.Sensitizing the mother's body forms antibodies to platelets, penetrating through the wall of the placenta into the bloodstream of the fetus and lead to the destruction of its own platelets.The cause of the acquired thrombocytopenia are intoxication, drug allergies, infectious diseases, elevated thyroid hormone.
symptoms in children do not differ significantly from those manifestations in adults.Cheerleaders parents must constantly nosebleeds, rashes punctulate in the lower extremities of the body, instant manifestation of bruising with minor mechanical effects, hematuria.But such conditions do not cause trouble, because there is no pain and significant clinical signs.Therein lies a great danger to the health of young patients, because it is the root cause severe bleeding in internal organs and the brain, which can result in lethal.
Children thrombocytopenia is divided into primary and secondary arisen.The first form is characterized by thrombotic thrombocytopenic syndrome accompanied by the absence of other pathology.Secondary forms of thrombocytopenia seen complications of the underlying disease.For example, it cirrhosis, human immunodeficiency virus infection and leukemias.
Based on the degree of influence on the development of immune complex disease in infants, immune and preimmune distinguish thrombocytopenia.Immune thrombocytopenia associated with massive loss of blood platelets as a result of exposure to antibody.Condition wherein the child's immune system does not differentiate between platelets and accepts them as foreign by the body, which leads to the production of antibodies.Sometimes aploimmunnaya, transimmunnaya, geteroimmunnaya and a variety of autoimmune diseases in this category.Not Immune Thrombocytopenia occurs when platelet mechanical damage.
autoimmune thrombocytopenia characterized by destruction of platelets due to the effect of autoantibodies.The main destination for their maturation is the spleen.It also passes the death of platelets damaged by autoantibodies.In addition, macrophages destroy platelets such organs as the liver and lymph nodes.The frequency of the disease, according to statistics, 1 in 15,000 cases, and exposed him to a greater extent women age group from 25 to 55 years.
Autoimmune thrombocytopenia usually has an acute onset, but can sometimes be a slow development.A typical symptom of autoimmune thrombocytopenia is a hemorrhagic petechiae, localized in the skin and mucous membranes.Spots painless to palpation, clinical inflammation is absent.Patients are observed bleeding from the nose of the internal organs of the gastrointestinal tract and of the uterine cavity.The most serious complication is bleeding hemorrhagic diathesis of the retina, leading to blindness.
Severity of this syndrome is dependent on quantitative content of platelets in the bloodstream.Low numbers index cause spontaneous bleeding.But no matter how paradoxical it may sound, with the attendant high fever or generalized infections can cause severe bleeding.
Clinic autoimmune thrombocytopenia with bleeding begins in the lining of the mouth and in contact with the garment body.Hemorrhage in the face and conjunctiva - a poor diagnostic feature.
for diagnosis autoimmune thrombocytopenia other than putting conventional tests (complete blood count, urinalysis, etc.) carried out special tests.