Thrombocytopenia
Introduction
Introduction to thrombocytopenia Thrombocytopenia is a condition caused by a lower than normal platelet count. Thrombocytopenia may be caused by insufficient platelet production, spleen retention of platelets, increased platelet destruction or utilization, and dilution, which is severe for whatever reason. Thrombocytopenia can cause typical bleeding: multiple ecchymoses, most common in the lower leg; or small scattered ecchymoses in areas with minor trauma; mucosal bleeding, nosebleeds, gastrointestinal and genitourinary tract and vagina Bleeding, and massive bleeding after surgery, massive bleeding in the gastrointestinal tract and bleeding in the central nervous system can be life-threatening. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: nosebleeds, gastrointestinal bleeding
Cause
Causes of thrombocytopenia
Causes
Reduced or ineffective death from thrombocytosis: both hereditary and acquired. The reduction in acquired thrombocytopenia is caused by damage to hematopoietic stem cells such as drugs, malignant tumors, infections, ionizing radiation, etc., or to their proliferation in the bone marrow. These factors can affect multiple hematopoietic cell systems, often accompanied by varying degrees of anemia, leukopenia, and marked reduction in bone marrow megakaryocytes.
Excessive platelet destruction: including congenital and acquired, excessive acquired platelet destruction including immune and non-immune, excessive immune platelet destruction, idiopathic thrombocytopenic purpura and drug thrombocytopenia, non- Excessive destruction of immune thrombocytopenia includes infection, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura and the like.
Platelets are excessively retained in the spleen: most common in hypersplenism.
Prevention
Thrombocytopenia prevention
1, diet prevention: for the prevention of thrombocytopenia, but also pay attention to the patient should not eat greasy, hard food, shrimp, crab and jellyfish hair is also not suitable for food, especially the yin deficiency heat must also be taboo thorny, fried Stir-fried barbecue. It is advisable to eat light, low-fat, high-protein foods. The most important thing about thrombocytopenia is iron supplementation. Eat more blood tofu, leeks and other foods and vegetables with high iron content. The rest should be recommended to see a doctor according to your own conditions and conditions.
2, enhance physical fitness should strengthen the living adjustment, get up early and get up early, enhance physical fitness.
Complication
Thrombocytopenia complications Complications, nosebleed, gastrointestinal bleeding
Common complications of this disease:
1. Mucosal bleeding: nosebleeds, gastrointestinal and genitourinary tract and vaginal bleeding.
2. A large amount of bleeding after surgery.
3. Massive bleeding in the gastrointestinal tract and bleeding in the central nervous system can be life-threatening.
Symptom
Symptoms of thrombocytopenia Common symptoms thrombocytopenia intravascular coagulation sputum jaundice bacteremia skin purpura blood heat immunodeficiency pale pale fatigue
First, drug-induced immune thrombocytopenia bleeding symptoms before the occurrence of incubation period, the short can be within a few hours after taking the drug, the elderly can be a few months after the onset, usually 5-10 days, often accompanied by chills, fever, headache , nausea, vomiting, etc.
Second, other immune thrombocytopenic disease teaching systemic skin purpura, nasal discharge or female menorrhagia, fatigue, weakness, pale, dark urine, occasionally visible signs of kidney damage such as hypertension, hematuria, azotemia, etc. The symptoms of the nervous system are rare.
Third, the outbreak of coagulopathy:
1. Aplastic anemia and bone marrow disease: aplastic anemia caused by various causes, such as reduction of bone marrow megakaryocytes and reduction of platelet production. Thrombocytopenia may be the earliest manifestation of aplastic anemia. It may be that after treatment, hemoglobin and granulocytes return to normal, platelets have not recovered, and bone marrow disease such as cancer cells infiltrate with thrombocytopenia. Most of the tumor cells damage giant nucleus and thin legs, so platelet production is reduced. Can be clearly diagnosed, the former bone marrow hyperplasia, megakaryocytes decreased; the latter can be found tumor cells.
2, physical and chemical factors inhibit bone marrow: physical and chemical factors such as ionizing radiation, alkylating agents, antimetabolites, cytotoxic agents, etc. in the treatment of malignant tumors, thrombocytopenia is a common complication, or directly poison bone marrow cells, or immune response, Most of these factors cause diffuse bone marrow damage, and patients show a reduction in whole blood, but a few patients with megakaryocytes are more sensitive to radiation, because some diseases can only show thrombocytopenia and megakaryocytes decrease.
3. Factors that selectively inhibit megakaryocytes: chlorothiazide drugs and their synergists can cause thrombocytopenia, in addition to the mechanism of platelet antibodies, but also inhibit platelet production, and the latter is more important, generally considered to be The role of pharmacology, patients with bone marrow suppression, megakaryocytes decreased, light asymptomatic patients can take up to 25 of this drug, individual pregnant women can cause congenital thrombocytopenia after taking this drug, the mother can be asymptomatic .
4, congenital megakaryocyte production is poor: the disease is rare, megakaryocytes and platelets are significantly reduced, often accompanied by congenital malformations, such as kidney, heart, bone, etc., the prognosis is poor, about 2 / 3 children died within 8 months Intracranial hemorrhage, maternal pregnancy with rubella, oral D860 can be a disease factor.
5, other: estrogen can occasionally cause no megakaryocyte thrombocytopenia, ethanol can inhibit platelet production, which is a common cause of long-term heavy drinking into thrombocytopenia, clinically rare bleeding, stop drinking, platelets can be restored .
IV. Ineffective thrombocytosis is common in some patients with megaloblastic anemia with partial vitamin B12 or folic acid deficiency. It is characterized by thrombocytopenia, some patients have bleeding tendency, some show reduced whole blood, and bone marrow megakaryocytes are normal or even increased. Therefore, for ineffective thrombocytopenia, platelets can return to normal with the treatment of poor young people.
5. Thrombopoietin deficiency This disease is caused by thrombocytopenia caused by congenital thrombopoietin deficiency. This disease is mostly hereditary. It has bleeding in infancy, platelet count is reduced, megakaryocyte number is normal, morphology and structure. No special changes.
Sixth, periodic thrombocytopenia This disease is a hemorrhagic disease caused by unexplained periodic thrombocytopenia. The disease is more common. Thrombocytopenia and platelet increase or normal alternate at regular intervals. The interval is usually 20 A 30-day, the disease is more common in women, its seizures are often consistent with menstruation, menstrual period thrombocytopenia, increased bleeding, megakaryocytes generally do not reduce, mainly skin and mucous membrane bleeding, no specific treatment.
Seven, thrombocytopenia caused by spleen disease Under normal circumstances, one third of the body's platelets are stagnant in the spleen, when there is splenomegaly such as portal hypertension, Gaucher's disease, lymphoma, sarcoidosis, Folty syndrome, etc. The platelet count can be reduced, but the total amount of platelets in the body is not reduced. After injection: adrenaline, the platelet count can be significantly increased within a certain period of time. Sometimes, there may be factors of increased platelet destruction.
Eight, infectious thrombocytopenia This disease is a thrombocytopenic bleeding disease caused by viruses, bacteria or other infections.
1. Viral infection: viral infections that can cause thrombocytopenia include measles, rubella, herpes simplex, chickenpox, cytomegalovirus infection, viral hepatitis, influenza, mumps, infectious mononucleosis, epidemic hemorrhagic fever, cats In the case of claw heat, dengue fever, etc., the virus can invade megakaryocytes, reduce platelet production, and the virus can also adsorb to platelets, resulting in increased platelet destruction; some patients with severe measles and epidemic hemorrhagic fever consume platelets due to disseminated intravascular coagulation.
2, bacterial infection: many bacterial infections can cause thrombocytopenia, including Gram-positive and negative bacterial sepsis, meningococcus, bacteremia, typhoid fever, tuberculosis, bacterial endocarditis, scarlet fever, brucellosis, Bacterial toxins inhibit platelet production, or increase platelet destruction, and may also increase platelet consumption due to toxins affecting vascular wall function. In short, patients with simple thrombocytopenia should consider the disease if there is a clear sign of infection. After primary infection control, Then the platelets recover.
Examine
Thrombocytopenia examination
Peripheral blood count is a critical test for determining thrombocytopenia and its severity, and blood smears can provide clues to its cause, if thrombocytopenia is not associated with other diseases that affect hemostasis (eg liver disease or diffuse blood vessels) Internal coagulation), hemostatic function screening test is normal. Bone marrow examination If there is an abnormality other than thrombocytopenia on the blood smear, there is an indication for this examination. This test provides information on the number and morphology of megakaryocytes and determines the presence or absence of a disease that causes bone marrow failure (eg, abnormal bone marrow hyperplasia). Antiplatelet antibody testing is of little clinical significance if the patient's medical history or examination provides a risk of HIV infection. Based on this, HIV antibody tests should be performed.
Diagnosis
Diagnosis and diagnosis of thrombocytopenia
diagnosis
The patient's medication history must be thoroughly understood to rule out drugs that increase platelet damage in sensitive patients. About 5% of patients receiving heparin treatment can develop thrombocytopenia. In order to maintain the patency of the arteriovenous infusion catheter, it can occur even if a small amount of heparin is used. Other drugs are less likely to induce thrombocytopenia, such as quinidine, quinine, sulfonamides, oral antidiabetics, gold salts, and rifampicin.
There is also a very important content in the medical history, which may lead to symptoms suggesting immune basic diseases (such as joint pain, Raynaud's phenomenon, unknown fever); signs and symptoms of thrombotic thrombocytopenia; lost within 10 days Blood tips may be cyanosis after transfusion, and heavy drinking suggests alcohol-induced thrombocytopenia. 5% of pregnant women may have mild thrombocytopenia during childbirth. Because patients with human immunodeficiency virus (HIV) are often associated with thrombocytopenia, they can be differentiated from idiopathic thrombocytopenic purpura; thus, other risk factors and medical history of HIV infection symptoms can be derived.
Physical examination is also important for diagnosis: (1) fever usually occurs in thrombocytopenia and thrombotic thrombocytopenia (TTP) secondary to infectious or active systemic lupus erythematosus (SLE), but in idiopathic thrombocytopenia Sexual purpura (ITP) and drug-related purpura do not produce fever. (2) The spleen percussion of patients with thrombocytopenia caused by increased platelet destruction (such as idiopathic thrombocytopenic purpura, drug-related immune thrombocytopenia, thrombotic thrombocytopenic purpura) does not increase; The spleen of patients with thrombocytopenia secondary to platelet retention in the spleen can be mostly affected, as is the case with patients with thrombocytopenia secondary to lymphoma or myeloproliferative diseases. (3) Signs of other chronic liver diseases are also meaningful for diagnosis, such as spider mites, jaundice and liver palm. (4) At the end of pregnancy, thrombocytopenia is often caused.
Peripheral blood count is a critical test for determining thrombocytopenia and its severity, and blood smears can provide clues to its cause, if thrombocytopenia is not associated with other diseases that affect hemostasis (eg liver disease or diffuse blood vessels) Internal coagulation), hemostatic function screening test is normal. Bone marrow examination If there is an abnormality other than thrombocytopenia on the blood smear, there is an indication for this examination. This test provides information on the number and morphology of megakaryocytes and determines the presence or absence of a disease that causes bone marrow failure (eg, abnormal bone marrow hyperplasia). Anti-platelet antibody tests have little clinical significance. If a patient's medical history or examination provides a basis for the risk of HIV infection, an HIV antibody test should be performed.
Differential diagnosis
(1) Thrombocytopenia caused by acute viral infection: viremia can cause platelet aggregation and destruction and the number is reduced, not caused by immune mechanism. It is characterized by thrombocytopenia occurring in the early stage of infection, and the degree of reduction is directly proportional to the severity of infection. Improved and platelet rise, PA-IgG does not increase, these can be identified with ITP.
(B) thrombocytopenia caused by infection with DIC: also occurs in the acute phase of infection, bleeding symptoms and systemic symptoms are more severe than acute ITP, thrombocytopenia progresses faster, prolonged prothrombin time, decreased fibrinogen, 3P Laboratory tests such as positive tests can be identified.
(C) drug-induced thrombocytopenic purpura: there are quinidine, urinary sputum derivatives, sulfa, neomycin, digitalis and other drug history, often accompanied by chills, fever, headache, vomiting, etc. Systemic symptoms, as well as combined with laboratory tests, can be identified.
(D) secondary thrombocytopenic purpura: such as acute leukemia, aplastic anemia, hypersplenism, systemic lupus erythematosus, Evans syndrome, rheumatoid arthritis, giant hemangioma, Wiskott-Aldrich syndrome, thrombosis Spontaneous thrombocytopenic purpura and bone marrow infiltration of various malignant tumors can cause secondary thrombocytopenia, which should be identified by combining the clinical features of the disease and the corresponding laboratory tests.
