What is thrombocytopenia
Thrombocytopenia can be independentdisease or a symptom of a number of pathological conditions (both acquired and hereditary): it may be caused by increased platelet destruction, increased consumption of or inadequate education.
In most cases of thrombocytopenia are acquired. They vary depending on the pathogenesis and causes of damage to platelets or megakaryocytes.
It acquired thrombocytopenia include: immune thrombocytopenia, in which antibodies are formed by blood transfusions or enter the body of the fetus from the mother; thrombocytopenia due to inhibition of proliferation of bone marrow cells; thrombocytopenia associated with somatic mutations myelopoiesis progenitor cells; thrombocytopenia consumption observed in thrombosis, extensive hemorrhages, severe splenomegaly; thrombocytopenia due to bone marrow emerging replacement tumor, such as metastatic cancer to the bone marrow, hemoblastosis; thrombocytopenia due to mechanical damage of platelets in hemangiomas, pronounced splenomegaly in the presence of artificial heart valves, thrombocytopenia with vitamin B12 deficiency or folic acid. In clinical practice, the most frequently encountered immune thrombocytopenia associated with the effect on platelet antibodies.
There are a group of inherited thrombocytopenia,caused platelet deficiency, which leads to a shortening of the duration of their life. When hereditary thrombocytopenia often observed changes in various functional properties of platelets, which gives reason to refer them to thrombocytopathy group. To carry hereditary thrombocytopenia due to defective platelet membranes, combined with the violation of their functional state.
All forms of thrombocytopenia characterized asusually painless spotty bleeding. In most of thrombocytopenia observed bleeding in the skin, or different types of bleeding from mucous membranes (gingival, nasal, gastrointestinal and others.).
In patients with thrombocytopenia at a blood testmarked decline in the number of platelets up to complete disappearance, normal or high content of plasma coagulation factors, reduced consumption of prothrombin, a violation of a blood clot retraction (retraction is sometimes absent). In severe thrombocytopenia in most patients, bleeding time increased. Because of the increased capillary fragility associated with impaired angiotroficheskoy platelet function tests on capillary resistance, such as Jar test, sharply positive. In the diagnosis of hereditary thrombocytopenia plays an important role of platelet morphological analysis (their size, structure), the determination of their functional properties.
How is the treatment of thrombocytopenia
All patients with any signs of hemorrhagic syndrome should be hospitalized.
With an increase in the number of subcutaneous hemorrhagein the monitoring of patients and / or accession bleeding shows hormone therapy. Prednisolone as initial therapy administered in an average daily dose of 60 mg / m2 (corresponding to 2 mg / kg per day) for 3 weeks to 3 times a day (600, 1000, 1400), taking into account circadian biorhythm - 2/3 prednisolone daily dose given in the morning hours.
Upon reaching full remission dose prednisone is reduced to 5.10 mg 3 days and discontinued.
If there is a patient of serious bleedinghormones initial dose may be 3-5 mg / kg per day for 3-5 days before hemorrhagic syndrome with edema and then transition to a dose of 2 mg / kg per day. An alternative way may be pulse therapy: methylprednisolone 30mg / kg per day for three days (Infusion time - at least 20 minutes) to edema and hemorrhagic syndrome platelet increasing to a safe level (more than 20,000).
Primary or alternative therapy may be introduction of intravenous immunoglobulin (IgG / w). The preparations used: Octagam, pentaglobin.
Also during thrombocytopenia sharply limited motor mode.
- angioprotectors - Dicynonum;
- fibrinolysis inhibitors - aminocaproic acid 0.2-0.5 g / kg per day;
- local methods of hemostasis.
The duration of the disease for more than 6 monthsevidence of the chronic form of the disease, although there is a possibility of spontaneous recovery even after a few years, as real possibility of a new deterioration of the (crisis) or continuously relapsing course.
All patients should be excluded and aspirinother antiplatelet and / or anticoagulant. Do not make an intramuscular injection. Vaccination eliminated and allergens (including nutritional), since they can increase the degree of thrombocytopenia. Sport activities must be stopped to prevent the possibility of injury. Swimming in this sense is more secure. If the patient has a reasonably active lifestyle requires symptomatic therapy: alternating courses of herbal medicine (nettle, yarrow, rose hips, shepherd's purse, arnica, etc..) With angioprotectors (Dicynonum - 1 x 3-p etc., Magnum With 0,25-0.. 5 x 1p., traumel 1t. x 3 p.).
It must be emphasized - treatment should be carried out individually.