Thrombocytosis - this increase in the number of platelets in the blood.When platelets thrombocytosis can reach about 500,000 per cu.mm.The causes of this disease may be too rapid production of platelets in the bone marrow, slowing their degradation, changes in their distribution in the bloodstream and other.
Thrombocytosis blood is the precipitating factor in the formation of blood clots.In certain cases, thrombocytosis can lead to bleeding due to platelet defects due to impaired microcirculation.Therapy thrombocytosis is thrombosis prevention and treatment of the underlying disease, which causes an increase in the level of platelets.
Figuring out the type of thrombocytosis is considered extremely important because blood clonal thrombocytosis is often accompanied by the formation of thrombotic complications and require a thorough physical examination.
When other myeloproliferative disease (polycythemia vera, chronic leukemia, essential thrombocy
Thrombocytosis is of several types: clonal thrombocytosis, primary thrombocytosis, secondary thrombocytosis.At its core, and the primary clonal thrombocytosis have a similar pattern of development.
In clonal thrombocytosis cause of the defect itself appears hematopoietic stem cells.These tumor stem cells have the character in case of chronic myeloproliferative state current.They also have high sensitivity to thrombopoietin and have no particular depending on the stimulation of the exocrine system.Platelet production in this case is an uncontrolled process, though functionally defective platelets themselves, whereby, disrupted their interaction with other substances and cells, stimulating clot formation.
Primary thrombocytosis are so-called myeloproliferative syndrome, which interferes with the work in the bone marrow stem cells and observed the proliferation of several sections of blood formation in the body.Because the peripheral blood, a large number of platelets.
secondary thrombocytosis develops due to the increasing number of platelet levels in chronic disease.Currently identify several reasons for its development.
most common cause of secondary thrombocytosis is an infection.Infectious factors include: meningococcal infection, viruses, fungi, parasites.
addition to infectious agents, there are other factors: Hematology (iron deficiency with anemia, the use of chemotherapy in cancer states);splenectomy (1/3 of the total number of platelets that accumulate in the body after the removal of which decreases the amount of blood with an artificial increase of platelets);surgery and trauma;inflammatory processes provoke an increase in platelet count (increased levels of interleukin, which causes enhanced production of thrombopoietin);oncological conditions;medications (corticosteroids in sympathomimetic antimitotics, contraceptive pills).
Thrombocytosis in pregnancy is, in most cases reversible condition and explained the physiological processes in the child-bearing.These include: slowing of metabolism, increase of blood, iron deficiency anemia pregnant women and others.
Primary thrombocytosis myeloproliferative diseases referred to character, which shows a significant increase in the number of blood platelets.In connection with these patients develop trombogemorragichesky syndrome.The basis of this lie thrombocytosis development of disseminated intravascular coagulation blood cells and mikrotsirkulyatsionnye violations.Also, platelet aggregation is disrupted.The incidence in men and women the same.The first signs of blood thrombocytosis appear more often at the age of 50 years.
Patients complain of bleeding (uterine, nasal, intestinal, kidney, etc..), Ecchymosis, subcutaneous hemorrhage localization, cyanosis of the skin and mucous membranes, itchy skin, tingling in the fingers and toes.In some cases, developing gangrene.In addition to bleeding in patients with thrombocytosis may be present such diseases as vascular dystonia (cold extremities, headaches type migraine, unstable blood pressure, tachycardia, shortness of breath, etc.), venous thrombosis (splenic, portal, liver, uterine(15 mm)).
However, blood clots can not only in veins, but also in arteries (carotid, mesenteric, pulmonary, brain and others.).Platelet content in the blood reaches from 800 to 1250. The microscopic analysis of blood platelets are presented in the form of large aggregates.In some cases, platelets reach gigantic dimensions, with a modified form of vacuolization and, with the detection of megakaryocytes or their fragments.The content of leukocytes usually reaches high levels (10-15), WBC is not changed.It can be increased hemoglobin and erythrocytes.
If recurrent bleeding may develop iron deficiency anemia.During the study in bone marrow trephine biopsy of the bone marrow is not trehrostkovaya expressed hyperplasia, detected increase in megakaryocytes (more than 5 in the field of view).In some cases there myelofibrosis, and to increase spleen not expressed indicators.
secondary thrombocytosis developed as pathological and under physiological conditions.It is characterized by the same symptoms as the primary.
Thrombocytosis detected during internal survey physician, laboratory blood tests, aspiration biopsy and a bone marrow biopsy (trepanobiopsy).
Reactive thrombocytosis is characterized by increased levels of platelets due to non-specific activation of the thrombopoietin (the hormone that regulates maturation, division and flow of blood platelets).Such a process promotes the formation of large numbers of platelets without pathological changes in their functional properties.
for reactive thrombocytosis causes of their appearance can be presented acute and chronic processes.Acute processes include: blood loss, acute inflammatory or infectious diseases, excessive physical activity, platelet recovery after undergoing thrombocytopenia.Chronic processes include: iron deficiency anemia, hemolytic anemia, asplenia, oncologic process, rheumatism, inflammatory bowel disease, tuberculosis, lung disease, a reaction to some drugs (vincristine, cytokines, etc.).
Under certain conditions, the disease occurs as a result of poisoning with ethanol (alcohol addiction).It is important to differentiate reactive thrombocytosis because it is often confused with clonal thrombocytosis.If clonal thrombocytosis causes of the disease difficult to diagnose, it is for the jet does not cause much difficulty, although clinically they are poorly expressed.For clonal thrombocytosis are also typical: peripheral or central ischemia, thrombosis of major arteries and / or veins, bleeding, splenomegaly, gigantic dimensions and a violation of their platelet function, increased megakaryocytes.Also for the detection of clonal thrombocytosis is characterized by dysplastic giant polyploid forms with high content of traces of platelets in the study of their morphology.
for reactive thrombocytosis is characterized by: a normal morphological pattern, the lack of central or peripheral ischemia, the lack of bleeding and splenomegaly, increased megakaryocytes in the bone marrow biopsy, there is no risk of thrombosis of veins and arteries.
Dynamic observation can afford to admit reactive thrombocytosis with normal levels of platelets in the treatment of diseases caused thrombocytosis.For example, trauma and neurological disorders, thrombocytosis is formed during the first days of the disease, and because of the correct treatment for two weeks passed quickly.
described cases of reactive thrombocytosis as a result of drug use, which in spite of significant figures in platelet count (500), is not dangerous for the occurrence of thrombotic complications and disappears after treatment.
Because, in the treatment of reactive thrombocytosis is necessary to identify the causes of disease.This requires medical history with the identification of episodes of thrombosis and microcirculation disorders in the past;Laboratory blood tests, biochemical studies on markers of inflammation (C-reactive protein, seromucoid, thymol test, fibrinogen);US - study of internal organs.
Relying on the results of diagnostics data, form the treatment strategy.If not the marked thrombocytosis (up to 600), with the absence of the risk of thrombosis, the patient is prescribed treatment of the underlying disease with the constant observation of the platelet count.
Essential thrombocytosis is characterized by a marked increase in platelet function and morphology that are often changed, which seems to cause symptoms such as thrombosis and bleeding.
Essential thrombocytosis is common in older people and older people.Clinical manifestations of the disease are very nonspecific, sometimes Essential thrombocytosis detected by chance that those who do not complain.However, the first clinical signs of the disease are spontaneous bleeding of varying severity that often occur in the digestive tract and often repeated for several years.There may also be bleeding under the skin, thrombosis, which affects the small blood vessels may be accompanied by the emergence of peripheral gangrene or ulcers, areas and rodonalgia perfrigeration.In some patients, there is the appearance of splenomegaly - sometimes very severe and combined with hepatomegaly.There may be heart attacks spleen.
Laboratory diagnosis indicates an increase in platelet count to 3000, and the platelets themselves due to morphological and functional disorders.These disorders account for a paradoxical combination of bleeding and thrombosis.Hemoglobin and platelet morphological pattern are within normal limits, provided that prior to diagnosis was not bleeding.The number of leukocytes in the normal range.The duration of the bleeding can be severe, but the clotting time does not exceed the boundaries of normal values.The biopsy of the bone marrow revealed a pronounced change in the size and number of megakaryocytes, also hyperplasia of erythroid and myeloid.
of essential thrombocytosis have a tendency to chronic course, with a gradual increase in the platelet count in patients who do not receive treatment.The lethal outcome is caused by bleeding or thromboembolism.The treatment is to achieve a normal level of platelet parameters.Typically, this is used in the melphalan dose of 375-450 MBq.To reduce the risk of bleeding should also begin therapy and in patients without severe symptoms.When thrombotic pathologies can help aspirin or acetylsalicylic acid.
Thrombocytosis the child
known that platelets are a constituent element of the blood or cells that produce bone marrow and employees for blood clotting.The existence of individual platelets is preserved up to 8 days, after which they fall to the spleen, where they are destruction.Depending on age, the number of platelets, which are formed in bone marrow, can have significant differences.In newborn infants, their number is about 100-400, in children under one year - 150-360, in children older than one year - 200-300.
reason for the development of primary thrombocytosis in children may be leukemia, or leukemia.Causes of secondary thrombocytosis, are not associated with the hematopoietic function, are: pneumonia (lung inflammation), osteomyelitis (bone marrow inflammation, with subsequent destruction of the bones), anemia (low hemoglobin content in blood).
addition, thrombocytosis in children may indicate a bacterial or viral infection.It can be viral hepatitis or influenza, tick-borne encephalitis, or varicella zoster virus.Any infectious disease may increase the platelet count.
Thrombocytosis child may be caused by a fracture of long bones.This condition is seen in these patients, who underwent surgery to remove the spleen.Spleen takes not the last part in the metabolism of red blood cells, and its removal can only be carried out under the diseases that interfere with normal blood clotting.Such diseases include hemophilia, which is mostly found in males, and is still incurable.In hemophilia occurs insufficient production of platelets.
treatment of thrombocytosis in children should be carried out by treatment of the disease, which has caused an increase in platelet count, because here the main role played by high quality diagnostics.
If there is a clonal thrombocytosis, the treatment should be carried out by the appointment of antiplatelet agents.These include: Acetylsalicylic acid 500 mg three times a day for 7 days;Klobidogrel or Ticlopidine, wherein the dosage is taken into account age and body weight of the patient.We must keep in mind that short aspirin may determine it ulcerogenic effect arising in the appointment of the drug in minimal doses.It is necessary to rule out the presence of erosive and ulcerative lesions of the gastrointestinal tract to aspirin (acetylsalicylic acid), because of its reception may provoke bleeding.
If there are thrombosis or ischemia due to the development of thrombocytosis, it is necessary to conduct expressed antiplatelet therapy with anticoagulants directional (Heparin, Bivalirudin, Livarudin, Argotoban) and daily laboratory research level of platelets.In severe thrombocytosis resorted to cytostatic therapy and plateletpheresis (removal of platelets from the blood by separation).For successful treatment of thrombocytosis is necessary to conduct a comprehensive examination of the patient to identify the causes of the disease and related.
When pregnancy thrombocytosis corrected by Dipyridamole on 1 tab.2 times a day, which in addition to the antithrombotic effect, has immunomodulating and improve utero-placental blood flow effects.But it is worth remembering that thrombocytosis during pregnancy - a physiological phenomenon and rarely requires correction.
addition to drug therapy for essential thrombocytosis diet, which is determined by a competent balanced diet, and adhere to the principles of a healthy lifestyle.An important condition for this is a no smoking and use of ethanol (alcohol).
necessary to take food rich in iodine (kelp, nuts, seafood), calcium (dairy products), iron (red meat and offal), B vitamins (green vegetables).Do not be amiss to use fresh juices high in vitamin C (lemon, orange, pomegranate, cranberry, etc.).Such juices must be diluted with water in a ratio of 1: 1.
From traditional medicine to treat thrombocytosis recommended tincture of garlic, cocoa, ginger and hirudotherapy (treatment with leeches).