Under the influence of various adverse factors, the process of formation of new platelets is slowed down or the rate of destruction of existing ones is increased. As a result, the concentration of platelets in the blood decreases significantly, which is a pathological condition that threatens both the he alth and life of the patient. In this case, the diagnosis is thrombocytopenia.
What is this disease?
There are many causes of pathology, they can be factors of a biological, physical or chemical nature.
The mechanism of the development of the disease is the implementation of the following processes:
- Slow down the formation of platelets. Platelets are formed in the bone marrow from megakaryocytes. Disruption of the process can occur against the background of the development of a pathology of a malignant nature, radiation sickness, severe folic acid deficiency, hereditary factors, as well as taking certain medications.
- Increase rate of destruction or consumptionblood platelets. This mechanism is the most common cause of thrombocytopenia. It can develop with a normal or even increased number of progenitor cells - megakaryocytes. It is customary to talk about a disease when the rate of platelet destruction is higher than the compensatory capabilities of the red bone marrow.
- Increase in the amount of these blood cells in the spleen. Normally, the body contains a third of all platelets. In the big direction, the indicator changes, as a rule, with an increase in the size of the spleen. Simultaneously with the deposition of an excess number of platelets, they are excluded from the process of hemostasis. The remaining formed elements continue to participate in the circulation.
Thus, there are many causes of thrombocytopenia. Under the influence of each of them, one or another mechanism for the development of the disease is launched.
Reasons
Thrombocytopenia in men and women can be both congenital and acquired. In the first case, the signs of the disease begin to appear soon after the birth of the child.
The main causes of thrombocytopenia are the following hereditary pathologies:
- Wiskott-Aldrich Syndrome. This is an immunodeficiency condition, during the development of which platelets and lymphocytes are affected.
- May-Hegglin anomaly. This is a rare disorder that causes thrombocytopenia of varying severity.
- Bernard-Soulier Syndrome. This disorder is characterizednot only by a decrease in the level of platelets in the blood, but also by the gigantic size of the plates, as well as the tendency to sudden onset of bleeding.
- Chediak Anomaly - Higashi. This is a disease associated with cellular dysfunction of a generalized form.
- Fanconi syndrome. Characterized by multiple defects in the reabsorption of fluids in the renal tubules.
In addition, thrombocytopenia is considered congenital, the cause of which is an isolated lesion of a megakaryocyte germ located in the bone marrow.
The most frequently diagnosed disease acquired in the process of life. There are the following types of thrombocytopenia:
- Breeding.
- Distributions.
- Consumption.
- Due to increased rate of platelet destruction.
- Productive.
In both men and women, the cause of dilutional thrombocytopenia is the replacement of severe blood loss with various solutions. As a rule, the concentration of plates is reduced by a quarter of the original value.
The cause of thrombocytopenia distribution is an increased degree of platelet deposition in an enlarged spleen. Normally, only a third of their total mass is deposited. Most of the plates remain in the enlarged spleen. In the body, various regulatory systems are responsible for controlling the total number of platelets, but they do not exercise it over the concentration of these formed elements in the blood. As a result, the process of increasedplatelet formation.
Thus, in adults, the cause of thrombocytopenia is splenomegaly (an enlarged spleen). It may occur due to:
- hemangiomas;
- excessive consumption of alcoholic beverages;
- sarcoidosis;
- tuberculosis of the spleen;
- lymphomas;
- myeloproliferative pathologies;
- Felty syndrome;
- Gaucher disease.
At the same time, alcoholism is the cause of both thrombocytopenia and leukopenia. The lack of several formed elements at once leads not only to a violation of blood clotting, but also to a significant weakening of the immune system, since the task of leukocytes is to destroy pathogens.
In adults, the cause of consumption thrombocytopenia is the triggering of increased platelet activation in the vascular bed. As a result, the rate of blood clotting increases significantly. A natural result of increased consumption of platelets is an increase in their production. In this case, it is necessary to find out the cause of this condition as soon as possible. If it is not eliminated in a short time, the compensatory capabilities of the bone marrow are depleted. In most cases, the pathology occurs against the background of DIC.
The most common cause of thrombocytopenia in adults and children is an increase in the rate of destruction of the red platelets. The disease can be either immune or non-immune.
In the first case, the pathology can be:
- Alloimmune. In this form, the process of increased destruction of platelets is a consequence of blood incompatibility, the presence of antibodies during the transfusion of foreign uniform elements, or the penetration of these substances to the fetus from a woman immunized with an antigen that is absent from her, but present in the child. In this case, thrombocytopenia may be either neonatal or post-transfusion.
- Transimmune. Most often diagnosed in children. The cause of thrombocytopenia is the penetration of autoantibodies of the expectant mother through the placenta to the fetus.
- Heteroimmune. In this case, the formation of antibodies begins in response to the penetration of a foreign antigen into the body or to a change in the structure of the plates. In most cases, the disease develops against the background of the vital activity of viruses or the intake of certain medications (sedatives, antibiotics, antibacterial drugs, etc.). In children, the cause of heteroimmune thrombocytopenia is viral infections. The disease disappears after their successful treatment.
- Autoimmune. It occurs due to the formation of antibodies to the cells of one's own body. The main manifestation of the pathology is idiopathic thrombocytopenic purpura.
A non-immune disease occurs due to mechanical damage to the plates. This usually happens during surgery.
Productive thrombocytopenia develops when the bone marrow is not able to produce formed elements in the amount that the body needs.
In most cases, thiscondition observed at:
- myelodysplastic syndrome;
- acute leukemia;
- sarcoma;
- hypersensitivity to certain medications;
- radiation and chemotherapy;
- infectious diseases;
- excessive consumption of alcoholic beverages;
- deficiencies in folic acid and vitamin B12;
- exposure to harmful chemical compounds.
Thus, in some cases, pathology may appear due to the development of several mechanisms.
Often there is a reduced concentration of formed elements during pregnancy. The causes of thrombocytopenia during childbearing are the following diseases and conditions:
- Hormonal restructuring. Due to the changes, the life cycle of platelets is reduced, the process of their destruction starts earlier than in the prescribed 7 days.
- Uneven distribution of plates. In some areas of the circulatory system, their deficiency is noted, in others - an excess amount. At the same time, the indicator of the total mass remains normal.
- The rapid increase in blood volume. For pregnant women, this process is physiological, against its background, the number of platelets is sharply reduced.
- Infectious diseases. Simultaneously with the manifestation of standard symptoms, the doctor notes a change in the blood count.
- Wrong diet. An unbalanced diet leads to a deficiency of vitamin B12 and folic acid, which is one of the main causes of thrombocytopenia in pregnant women.
- Allergicreactions.
- Intoxication of the body. Occurs due to medication. It is important for pregnant women to be aware that all drugs affect platelet levels to some extent.
- HIV. The disease develops against the background of a significant weakening of the body's defenses.
- Bleeding. As a rule, they occur due to miscarriage and placental abruption.
- Pre-eclampsia and eclampsia.
- Pathologies of the kidneys.
During the bearing of a child, it is important to eliminate the cause in a timely manner. Treatment of thrombocytopenia in pregnant women and their further monitoring is carried out by a hematologist. At the same time, platelet levels should be monitored throughout the entire gestational period.
In addition, the disease is often diagnosed in people's favorite pets (both cats and dogs). The causes of thrombocytopenia in them are: drugs, neoplasms, infectious diseases, decreased immunity. Treatment of a pet must be entrusted to a veterinarian.
In most cases, a person has nothing to worry about. It is worth taking all necessary measures if a pet has a disease of an infectious nature. For example, toxoplasmosis, which is especially dangerous for pregnant women.
Degrees of severity
Thrombocytopenia can be an independent pathology, and serve as a sign of any disease. In any case, the attending physician needs information regarding the content of platelets in the fluid connective tissue. Based on thesedata, he can judge the severity of the disease.
Thrombocytopenia can be:
- Moderate.
- Sharp.
- Expressed.
Accordingly, in the first case, the concentration of plates decreases slightly, in the latter - to critical values.
Symptoms
In some cases, the course of the disease is not accompanied by any alarming signs. You should consult a hematologist if you experience the following symptoms:
- Skin hemorrhages are pronounced even if minor bruises were received.
- Small red rash, mostly on legs.
- The consequence of even minimal mechanical impact on the mucous membranes is bleeding.
- Heavy menstruation in women.
- Frequent bleeding from the nose and ears.
- Presence of fluid connective tissue in urine and feces.
- After receiving minor injuries, accompanied by a violation of the integrity of the skin, it is extremely difficult to stop the bleeding.
- Increased gum sensitivity. Bleeding occurs when brushing teeth and eating solid foods.
At the earliest stage, a person, as a rule, does not feel any changes in the body. In most cases, the disease is detected during an examination prescribed for the diagnosis of another pathology. A disease of moderate severity is characterized by moderately severe symptoms. At this stage, hemorrhagic rashes most often appear. The last stage in whichthe platelet level drops to critical values, is the most dangerous. In such cases, hemorrhages can occur in any part of the human body.
Diagnosis
Regardless of the causes of thrombocytopenia, a hematologist is responsible for the treatment and follow-up of the patient. During the appointment, the doctor conducts an initial diagnosis, including questioning the person and palpation, which confirms or excludes the fact of an increase in the spleen in size.
For an accurate diagnosis, a hematologist prescribes a complete blood count, as well as a study of fluid connective tissue for clotting and for the presence of antibodies to platelets. Based on the results, the doctor may recommend a small amount of bone marrow for analysis. With the help of this study, a specialist has the opportunity to assess the state of the hematopoietic process, as well as to detect quantitative and qualitative changes in the cells involved in it.
In order to determine the size of the spleen and detect pathological changes in other organs, it is necessary to undergo an ultrasound or MRI. Based on the results obtained, the doctor can determine the cause of thrombocytopenia and prescribe treatment in accordance with the individual characteristics of the patient's he alth.
Drug therapy
Currently, there are several effective schemes with which it is possible to improve the course of the disease or get rid of it altogether.
Depending oncauses treatment of thrombocytopenia in adults can be carried out with the following drugs and substances:
- Glucocorticosteroid hormones. The task of these funds is to destroy the interaction of platelets and antibodies to them. Against the background of their intake, the destruction of platelets slows down. In addition, the speed of the same process in the spleen decreases, due to which the concentration of platelets in the liquid connective tissue increases. In most cases, doctors prescribe Prednisolone or Methylprednisolone. The dosage of the drug is calculated individually. The course of treatment is from 1 to 4 months. Experts judge the effectiveness of such therapy after its completion. If treatment with glucocorticosteroids did not affect the course of the disease, drugs of this action are not prescribed in the future.
- Non-hormonal immunosuppressants. Against the background of taking these drugs, the production of antibodies against one's own platelets decreases. A natural consequence is a slowdown in the destruction of platelets and an increase in the duration of their life cycle. As a rule, the following agents are prescribed for the treatment of pathology: Azathioprine, Vincristine, Cyclophosphamide. The course of treatment is several weeks. At the same time, a blood test is regularly carried out for control.
- Means, the active substance of which is danazol. Currently, the mechanism of action of such drugs has not been fully studied, but it has been proven that with prolonged use of them, the level of platelets in the blood increases significantly. These medicines are most effectiveshow in the treatment of persons over 45.
- Immunoglobulin. The substance reduces the activity of antibodies to its own platelets. Currently, this is the most effective method of treating autoimmune pathology. In addition, immunoglobulin preparations are administered intravenously in the presence of severe hemorrhagic syndrome. This is due to the fact that the substance increases the number of platelets in the blood in the shortest possible time, but this effect is short-lived.
- Interferon. This substance not only fights viruses, but also reduces the production of antibodies to its own platelets. This method of treatment is advisable to prescribe with the ineffectiveness of glucocorticosteroid drugs.
In addition to the above, symptomatic therapy is carried out. For example, in case of bleeding, aminocaproic acid is prescribed, for increased formation of blood clots at the wound site, the drug "Etamzilat".
When drawing up a treatment regimen for thrombocytopenia in children, the causes of the disease are taken into account last. Medications are prescribed only in the presence of pronounced symptoms. This tactic is explained by the fact that in children, the level of platelets most often normalizes without any intervention. In the absence of positive dynamics, glucocorticosteroids and cytostatics are usually prescribed.
Invasive procedures and splenectomy
In some cases, in order to normalize the level of platelets, plasmapheresis is used. The essence of the method isthe following: a catheter with a tube is installed for the patient, through which the required amount of biomaterial is taken. Next, a disposable container with blood is placed in a centrifuge, where the separation of plasma and formed elements takes place without violating the integrity of the cells. At the same time, antibodies to their own plates are removed from the liquid connective tissue. After completion of this process, the purified blood is returned to the bloodstream, and the separated plasma is replaced with fresh frozen.
Plasmapheresis is a procedure widely used to treat thrombocytopenia in children as well. The causes of the disease can be quite serious, but with its help in most cases it is possible to achieve positive dynamics. Most often, the method is used simultaneously with taking glucocorticosteroids.
Another way is transfusion of donor platelet mass. This method is used only in the presence of vital indications. In this case, it is desirable that platelets be taken from the patient's immediate family.
When medications and invasive procedures are ineffective, both children and adults are shown splenectomy. This is an operation that involves the removal of the spleen.
Indications for its implementation are also:
- Prolonged course of the disease (more than 12 months), the presence of more than 2 episodes of exacerbation after a course of hormonal treatment.
- Inability to take glucocorticosteroids (contraindications, serious side effects).
- After completing a course of hormonal therapy, relapses of pathology occur.
- Severe thrombocytopenia, when the patient has a pronounced hemorrhagic syndrome and various kinds of hemorrhage (including in the brain).
After a splenectomy, the process of platelet destruction slows down significantly, and the duration of their life cycle increases. The natural result is an increase in the level of platelets in the liquid connective tissue. Thus, surgery to remove the spleen can save patients admitted to the hospital with life-threatening bleeding. In an emergency, a splenectomy can also be performed during pregnancy.
Diet
The diet of a person with thrombocytopenia should be balanced. There are no strict dietary recommendations, but it is important to avoid foods that are strong allergens from the menu.
To improve blood clotting, you can additionally drink herbal decoctions. The following plants are suitable for this purpose: chamomile, peppermint, shepherd's purse, nettle. Decoctions can be either single or multi-component. Against the background of their intake, blood clotting improves, and vascular permeability also decreases.
Before using decoctions, it is recommended to consult with your doctor and exclude the presence of an allergy to a particular plant.
If left untreated?
Ignoring the presence of thrombocytopenia can lead to both external and internal bleeding. Atthe timely provision of medical care to the patient can be saved. The most dangerous is a cerebral hemorrhage due to the high percentage of deaths.
These conditions pose a threat to the life of the unborn child. During pregnancy, bleeding may occur, in which premature delivery is sometimes indicated. In addition, autoimmune thrombocytopenia can be passed on to the child.
As for young children, they should be regularly examined by a hematologist and pediatrician. If necessary, they are prescribed treatment, which can also protect against negative consequences.
In conclusion
Thrombocytopenia is a pathology caused by a significant decrease in the level of platelets in fluid connective tissue. Patients with a similar diagnosis should be regularly tested and follow all the instructions of the hematologist. The attending physician, in turn, must provide information about the causes of thrombocytopenia, what kind of disease it is and how dangerous it is for a person. The patient must understand that only timely treatment will help save him from serious consequences.
