Thrombocytopenia. Causes, diagnosis and treatment of low platelet count in the blood

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Ablyazov

Irshat Ravilevich

21 years of experience

Local therapist of the highest category. Member of the Russian Scientific Medical Society of Therapists.

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Thrombocytopenia is a separate disease or a symptom of another disease that is characterized by a low platelet count (less than 150,000 units per microliter). The condition is accompanied by high bleeding, as well as slow stopping of bleeding from small vessels.

Symptoms

Symptoms of thrombocytopenia include:

• Purpura. This is the name for hemorrhages in mucous tissues or skin. In fact, it looks like red spots - most often they can be seen in places of strong contact with clothing. The spots do not hurt, they can be pinpoint or quite extensive - including bruises of different colors (depending on the time of formation).
• Regular nosebleeds. Since small vessels are weakened, bleeding can begin due to a cold, sneezing, or minor injury. Bright red blood may flow for ten minutes or more, putting the patient at risk of losing a lot of blood.
• Bleeding gums, prolonged bleeding after tooth extraction. The mechanism is the same: due to weak blood vessels, the blood cannot stop quickly in case of small or large injuries.
• Bleeding of internal organs. For example, blood is found in the gastrointestinal tract, when the stool becomes colored, or in the genitourinary system - then the urine becomes colored. Both symptoms are very alarming and require immediate contact with specialists.
• Too heavy and long menstruation. Moreover, bleeding can be observed on other days of the cycle.

All of these symptoms may indicate other diseases - both concomitant with thrombocytopenia and independent. What complicates the situation is that there are a lot of reasons and mechanisms for the development of this condition. In medicine, there are several types of this disease.

Classification of thrombocytopenia

Let's talk about the causes of thrombocytopenia that underlie the different types of this disease.

Hereditary thrombocytopenias

These conditions are based on diseases of genetic origin. These may be May-Hegglin anomaly, Bernard-Soulier syndrome, Wiskott-Aldrich syndrome, TAR syndrome, as well as congenital amegakaryocytic thrombocytopenia.

Each of these diseases has many characteristics. For example, Wiskott-Aldrich syndrome occurs exclusively in boys and occurs in four to ten cases per million. Bernard-Soulier syndrome can only develop in a baby who has received the altered gene from both parents, and May-Hegglin anomaly can develop in 50% of cases, provided that only one parent has the prerequisites for this. As a rule, all of these diseases have among their symptoms not only a low level of platelets, but also a number of other pathological conditions, and therefore require special treatment.

Consequences of thrombocytopenia

Small deviations from the norm are not dangerous to human health. With timely diagnosis and treatment, patients can avoid the development of pathological consequences. However, if thrombocytopenia is ignored and there is no comprehensive treatment, sick people risk encountering the following pathologies:

• development of subcutaneous bruises with minor injuries;
• internal bleeding that poses a threat to human life;
• hemorrhage in the retina of the eye, which can result in blindness for a person;
• hemorrhagic stroke.

The patient may also experience bleeding in the brain. This is a rare, but quite dangerous phenomenon. It develops most often with serious head injuries, but can also occur spontaneously, without any bruises. Bleeding in the brain also occurs against the background of frequent nosebleeds. The prognosis in this case is unfavorable - a quarter of such cases end in the death of the sick person. The prognosis for recovery with a low platelet level depends on the characteristics of the patient’s body, his age, the duration of the disease, and the presence of auxiliary pathologies in the body.

Productive thrombocytopenia

They are also caused by a huge list of reasons and factors of various origins. All of them are associated with the fact that platelet formation processes in the red bone marrow are disrupted.

For example, this includes some types of anemia, cancer metastases, acute leukemia, and taking cytostatic medications. There are even factors such as radiation or alcohol abuse.

For example, in acute leukemia, a disease of the circulatory system causes a mutation in the bone marrow stem cell. Because of this, it divides and begins to displace hematopoietic cells. As a result, the number of not only platelets, but also leukocytes, erythrocytes, and lymphocytes decreases. This condition has its own name - pancytopenia. That is, immune thrombocytopenia in this case is part of it.

If we are talking about the effect of medications, then most often a decrease in platelet levels is caused by drugs from the following groups:

• antidiabetic,
• anti-inflammatory,
• antipsychotics,
• antithyroid,
• antibiotics,
• diuretics,
• anticonvulsants.

Of course, not all medications and not in all cases are capable of causing such a reaction, but this is another reason to think about the fact that you should not prescribe any medications yourself or take them without the supervision of your doctor.

Moreover, there is also such a factor as increased sensitivity to certain medications. Usually it is initially determined by a peculiar genetic predisposition, but this is quite rare.

When we talk about radiation, we are talking not only about a person’s presence in dangerous areas, but also about treatment with radiation therapy. When tumors are destroyed, the blood-forming cells of the red brain can be affected, so a condition where platelet levels drop can become a side effect of cancer treatment.

The development of symptoms of thrombocytopenia due to alcohol abuse most often occurs against the background of binge drinking and is associated with a high level of ethyl alcohol in the blood. It has negative and long-lasting effects on the bone marrow and usually causes a temporary decrease in platelets. If binge drinking becomes frequent and too long, there is a risk that the changes will be irreversible.

Preventive measures

In the early stages of the disease, patients can prevent its progression in the future. To do this, it is necessary to normalize the level of physical activity, that is, to abandon active training. It is permissible to perform only light warm-up and morning exercises. Patients with low platelet counts are advised to choose an office-type job. The basis for good health in thrombocytopenia is adequate sleep and proper nutrition. Adults need to sleep at least 9 hours a day.

As for the diet, women and men should avoid eating pickles, pickled foods, spicy and smoked foods. The use of alcohol and tobacco products, sugar, and hot seasonings is unacceptable. The emphasis in the diet should be on food of plant origin. Doctors do not recommend taking antibiotics and anti-inflammatory drugs such as Aspirin or Analgin during an exacerbation of the disease. To maintain the functioning of the body, you need to take vitamin and mineral complexes.

Thrombocytopenia destruction

Here we are talking about the active destruction of platelets, which is usually observed in the spleen. Such processes are also caused by a large number of factors. These include taking certain medications, some viruses, Fisher-Evans syndrome, etc.

Idiopathic thrombocytopenia deserves special consideration. This is the case when it is not possible to establish the cause even with a huge number of possible options. At the same time, doctors note that even in such a situation, the action of provoking factors is observed. For example, the problem appears after bacterial and viral infections, preventive vaccinations, use of a number of medications, hypothermia or prolonged exposure to the sun.

This condition also occurs in newborns. It begins to form in the womb, when antibodies in her body cause the destruction of platelets in the child.

Fisher-Evans syndrome is also not an independent cause, since it itself is a consequence of various systemic diseases. This syndrome occurs in systemic lupus erythematosus and rheumatoid arthritis, but in some cases it can be an independent deviation. As for viruses, rubella, chicken pox, measles, and influenza can lead to a decrease in platelet levels. Sometimes this is a reaction to vaccination, although such a mechanism is described quite rarely and almost never occurs.

Thrombocytopenia consumption

Here the mechanism is as follows: platelets, for some reason, begin to be activated in the vascular bed. In response to this, the red bone marrow begins to actively produce them - and as a result, its capabilities are slowly depleted. After this, the level of red cells begins to fall.

One of the causes of consumption thrombocytopenia is disseminated intravascular coagulation syndrome. It stands for disseminated intravascular coagulation syndrome. And it can develop against the background of severe tissue destruction during operations, burns, injuries, due to severe infections, chemotherapy, organ transplants, etc. That is, there are many underlying reasons that can cause a decrease in the level of platelets in the blood.

Low PLT levels in pregnant women

During pregnancy, a slight decrease in PLT is not a pathology. It can occur against the background of an unbalanced diet or the individual characteristics of a particular organism. Normally, the indicators should remain at the level of 100*109/l. If platelet levels drop below this level, this can lead to unpleasant consequences:

• bleeding during childbirth;
• miscarriage in the early stages of pregnancy;
• late toxicosis;
• early birth;
• internal hemorrhage.

At critically low levels, death is likely. If thrombocytopenia is suspected, a pregnant woman must undergo a clinical examination and also have a coagulogram. This is a procedure that determines the level of plasma coagulation in the body. You may also need to be tested for thrombophilia. This is a disease in which the concentration of PLT in the blood also decreases and problems with blood clotting occur.

If the doctor determines that low platelets are an independent symptom that arose against the background of hormonal changes in the body during pregnancy, after childbirth the indicators will normalize. If a blood clotting disorder occurs against the background of an internal disease, then complex treatment will be required. Such measures are necessary in order to eliminate the likelihood of problematic childbirth.

Thrombocytopenia redistribution

If we explain this mechanism very simply, it looks like this: due to some reasons, the patient’s spleen enlarges. And if under normal conditions it stores up to 30% of platelets, then in an enlarged state it retains up to 90% of these cells. At the same time, the system does not see that there are not enough platelets and does not trigger a compensatory mechanism.

The mechanism is also based on various causes: cirrhosis of the liver, some infections such as tuberculosis, autoimmune diseases (systemic lupus erythematosus), tumors of the circulatory system, alcoholism.

What to do in case of bleeding

If you start bleeding at home, take the following measures:

1. Apply direct pressure to the bleeding area. If you have a nosebleed, pinch the bridge of your nose and apply ice to it.
2. After applying pressure to the bleeding area, call your Memorial Sloan Kettering (MSK) doctor. If you cannot reach your doctor and are unable to stop the bleeding, go to your nearest emergency room.

When should you call your doctor?

Call your doctor right away if you have any of the following:

• black stools, blood in the stool, or bleeding from the rectum;
• blood in urine;
• persistent headache;
• blurred vision;
• dizziness;
• any persistent bleeding, including coughing up blood, vomiting blood, or bleeding from the nose.

to come back to the beginning

Thrombocytopenia dilution

This condition is usually observed in people who receive a large number of transfusions of various liquids: for example, plasma, plasma substitutes, etc. As a result, the level of platelets decreases due to the banal dilution of the blood.

Considering the huge number of reasons that can cause immune thrombocytopenia (and we have not named all the options), a patient with its symptoms should immediately consult a doctor who will find the essence of the problem and prescribe effective treatment.

Diagnostics

Since there are so many reasons, it is not possible to name diagnostic measures in detail - everything will depend on the specific situation. But we can highlight the main components of diagnosis:

• General blood analysis.
• Checking bleeding time (Duke test).
• Determining the time it takes for blood to clot.
• Red bone marrow puncture. The method allows you to identify quantitative and qualitative changes in cells.
• Determination of antibodies in blood.
• Research for genetic diseases.
• Ultrasound of internal organs. Most often, the liver and spleen are studied immediately, but this list can be very large.
• MRI. Used to study internal organs and blood vessels.

Diagnosis of the disease begins with a visit to a general practitioner, who, based on a survey, initial examinations and tests, prescribes visits to other specialists.

Platelet diagnostics

At the first appearance of relevant clinical symptoms (bleeding and bruising), it is necessary to consult a specialist, in this case it is a general practitioner. There is no need to postpone going to the doctor until the clinic gets worse, because in this case the treatment will be more difficult and the outcome will be less favorable.

To diagnose thrombocytopenia, you must first take a blood test. If the analysis reveals a low platelet count, the general practitioner may refer you to a hematologist, who will prescribe additional tests, such as:

• Coagulogram with determination of clotting time.
• Blood biochemistry for LDH, ASAT, ALAT and bilirubin.
• Antibody test.
• MRI.
• Ultrasound of the abdominal organs.
• Genetic studies (to exclude hereditary thrombocytopenia).

After conducting research and identifying the true cause of thrombocytopenia, a general practitioner or hematologist prescribes appropriate treatment, which includes eliminating the cause of the decrease in platelet count.

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• detailed explanation from the general practitioner.
• an alternative opinion from a competent specialist in interpreting the analyses.
• the opportunity to ask questions to the doctor regarding test results.

Treatment and severity

Treatment of thrombocytopenia most often comes down to identifying the primary disease and its treatment, as well as eliminating various unpleasant symptoms. In the process, it is also important to take into account that the severity of thrombocytopenia varies:

Mild degree. It assumes that the platelet concentration is from 50 to 150 thousand units per microliter. The condition of the capillaries is usually normal, bleeding does not develop. Usually, treatment is not necessary at this stage - doctors recommend waiting and monitoring the development of the patient’s condition.

Average degree. In this case, the concentration is 20-50 thousand platelet units per microliter. Under this condition, bleeding gums and nosebleeds are observed. If injuries and bruises occur, serious hemorrhages form in the skin. At this stage, drug therapy may be prescribed.

Severe degree. The platelet concentration is below 20 thousand, hemorrhages are spontaneous and severe. At the same time, the patient himself may feel quite comfortable, does not complain of feeling unwell, but tests show that he needs help.

Since the treatment of thrombocytopenia requires the most thorough and detailed diagnosis, it is important to choose a modern clinic that will help you. JSC "Medicine" in Moscow is just the place where you can get qualified help from the best specialists. The clinic has everything necessary for both examination and treatment of each patient.