Platelets: low, causes of lowindicators of what to do

Update: November 2018

A decrease in platelet count in the blood test is pretty
common situation. Withчины этого состояния бывают разные: от
oncology before counting errors. ATыраженная
failure of these cells in the blood is manifested by bleeding,
hemorrhagic rash, poor wound healing. For the right
treatment needs to establish the exact cause of this syndrome.

What are platelets

Platelets are classified as major blood cells. Although
these are not true cells, but fragments of the cytoplasm of large cells
bone marrow – megakaryocytes. Their old name is blood
plate, the term (blood platelets) is still used in
English literature. AT расшифровках анализов, проводимых на
hemoanalyzers, they are referred to as PLT.

By entering the blood, platelets perform their function there and through
7-10 days are destroyed in the spleen (mostly), in the liver and
lungs. The main purpose of these cells is vascular platelet.
hemostasis, that is, to stop bleeding when small ones are damaged
vessels. With определенных воздействиях они способны активироваться,
that is to stick together both among themselves and with the vascular
wall.

Activated platelets increase, they appear
processes that are much larger than the size of the plate itself. Damaged
the vessel is sealed with a blood clot, and the bleeding stops. With this
we face in everyday life: cut or pierced a finger,
removed the tooth – the blood from the wound is allocated no more than 3-5 minutes. This and
there is a vascular (primary) hemostasis, that is, work
platelet count.

Another function of these cells, discovered relatively recently –
allocation of growth factors and participation in wound healing.

Platelet count

For normal blood clotting it should contain
a certain number of platelets. Unit of measurement
It is considered one thousand in 1 microliter.

  • AT среднем норма составляет 150-400 Хл. Boundaries
    normal indicators depend on gender, age, physiological
    state counting methods.
  • Для мужчин нормой считается 200-400 Хл,
  • Для женщин – 150-320 Хл. ATо время месячных их
    the number can be reduced by 50%, then quickly restored.
    Some decrease in platelets below normal in pregnant women
    considered pathology, but the lower limit should not be
    less than 100 Chl.

Norms in children

ATозраст ребенка Platelet Norm
newborn 100-420 thousand U / μl
2 weeks – 1 year 150-350 thousand U / μl
1-5 years 180-380 thousand U / μl
5-7 years 180-450 thousand U / μl

Withчины снижения нормы тромбоцитов

Reduction of blood platelets in the blood of less than 100 Chl
called thrombocytopenia. Withчинами снижения тромбоцитов могут
to be as a violation of their formation in the bone marrow, and enhanced
destruction under the influence of external and internal factors. It often happens
it is quite difficult to establish the true cause.

Decreased platelets in an adult may be due to
different states:

  • Cancer of the blood – leukemia. With этом в костном
    the brain is uncontrolled proliferation of undifferentiated
    blast cells that inhibit normal shoots
    blood formation.
  • Hypo-and aplastic anemia, myelodysplastic syndromes. it
    a condition characterized by inhibition of blood formation in general. AT
    blood is marked not only anemia, but also low leukocytes and
    platelets.
  • Metastasis of malignant tumors in the bone marrow.
  • Violation of the division of erythrocytes and megakaryocytes as a result
    недостатка витамина AT12 и фолиевой кислоты.
  • Withем препаратов, угнетающих кроветворение (химиотерапия при
    oncological diseases).
  • ATоздействие ионизирующего излучения (лучевая болезнь,
    radiation therapy).
  • Withем некоторых лекарств, не являющихся цитостатиками, но
    leading to the formation of antibodies to megakaryocytes – hypothiazide,
    estrogens, quinidine, digitoxin, rifampicin, sulfonamides,
    carbamazepine and others). Drug thrombocytopenia manifests itself
    on the 3-4th day from the start of the drug and passes after it
    cancellation.
  • Некоторые вирусные инфекции (ATИЧ, инфекционный мононуклеоз,
    hepatitis, rubella, cytomegalovirus infection).
  • ATрожденные тромбоцитопении. Genetic changes lead not
    only to reduce the number, but also to change the quality of blood
    platelets (thrombocytopathy).
  • The formation of antibodies to platelets and their increased destruction –
    идиопатическая тромбоцитопеническая пурпура (ETC). Develops
    usually after infections, bright small-dotted
    rash on the trunk and extremities, bleeding.
  • Chronic alcoholism.
  • Cirrhosis of the liver. Lowered platelets are almost always detected.
    in this pathology, this is explained by the development of the portal
    hypertension, an enlarged spleen and increased destruction in it
    blood cells.
  • Autoimmune diseases are characterized by the production of antibodies
    against your own cells. Thrombocytopenia of such a mechanism
    called immune. These diseases include rheumatoid
    arthritis, systemic lupus erythematosus, antiphospholipid syndrome,
    sarcoidosis and others.
  • Pregnancy.
  • Blood transfusion and plasma.
  • DIC syndrome. This is a syndrome of exhaustion of the coagulation system,
    which develops often in septic conditions.
  • Mechanical thrombocytopenia – cell destruction in the presence of
    prosthetic heart valves during surgery using
    cardiopulmonary bypass, blood dialysis.

False Thrombocytopenia

A blood test on a hemoanalyzer often gives low numbers.
platelet without any other changes. There may be
a few reasons:

  • Very large blood plates the analyzer can read
    together with red blood cells.
  • Too small, he just “does not notice.”
  • When using EDTA anticoagulant, platelets can
    agglutinate (stick) to other blood cells and are not considered
    as separate elements.

Such thrombocytopenia is called false. If, when interpreting
the doctor has doubts about the result, you need to repeat the analysis
with platelet count in a smear under a microscope.

Symptoms of thrombocytopenia

What do low platelets in the blood say? Small number of them
leads to disruption of the microcirculatory phase of coagulation.

  • До уровня 50 тыс ЕД/мкл тромбоцитопения
    asymptomatic. The results of this platelet analysis
    is a signal for examination and further observation.
  • У пациентов с количеством тромбоцитов 30-50 тыс
    /мкл
    уже возможно появление петехиальной сыпи, при травме
    there will be a strong, long-lasting bleeding. In women with
    abnormal and prolonged
    menses.
  • Содержание кровяных пластинок от 10 до 30
    тыс/мкл
    приведет к кровоизлияниям уже при небольшой
    injury, there may be nosebleeds, easy bruising
    on the body from a slight pressure, at the injection sites, 
    bleeding gums, hemorrhage in the sclera of the eyes, in the mucous
    oral cavity. If a tooth is removed at this time, the blood from the wound is not
    will stay a few hours or even days.
  • Effects of low platelets when their number becomes
    менее 10 тыс/мкл, могут быть очень серьезными и
    even fatal. This condition is dangerous by the development of spontaneous
    bleeding even without injury – abundant nasal,
    gastrointestinal, from urinary tract, and also intracranial
    hemorrhage. Without help, the patient may die from blood loss.
    or hemorrhagic stroke.

What is platelet volume?

Sometimes to clarify the diagnosis except for quantitative calculation
platelets are required and their qualitative characteristics.
Modern automatic analyzers issue in decoding such
rates as average platelet volume (MPV), relative
the width of the distribution of platelets by volume (PDW), and
thrombokrit (PCT).

The fact is that the platelet population is heterogeneous, it
presented as large in volume (young) forms, and
small (older). The attention of the physician should involve analyzes
in which the average volume of platelets goes beyond the accepted norms.
This usually suggests thrombocytopathy, congenital and
acquired violations of their development and functioning.

Low platelets in a child

This condition is the most common pathology of clotting in
children. A child’s platelets may be low for the same reasons
as in an adult, but the structure of the incidence is still somewhat
is different. The most common in childhood immune
thrombocytopenia (ITP). It is primary (not related to other
diseases and causes) and secondary. 50% of cases is
heteroimmune form, its former name is idiopathic
thrombocytopenic purpura, or Werlhof’s disease. ITP can
manifest in the neonatal period, but more often children are ill in
age from 2 to 10 years.

The pathogenesis of the disease is the formation of antibodies against
platelets and their predecessors. The disease is usually acute.
1-2 weeks after viral infection. On the skin
there is a bright drain rash, superficial bruising. Also
nasal and other bleeding from mucous membranes may develop. General
The condition of the child does not suffer much. Profuse bleeding
atypical, and in most cases the disease proceeds
benign and with self-healing. Distinguish acute form
(duration up to 3 months), prolonged (up to 12 months) and
chronic (lasting more than a year).

In addition to ITP, other causes of low platelets are possible.
child, including cancer, chronic
viral infections, splenomegaly, genetic disorders. therefore
child must be fully examined. To congenital
thrombocytopenia include Wiskott-Aldrich syndrome, TAR syndrome,
Fanconi anemia.

ITP in children usually does not require treatment, the main tactic is
�”Watchful waiting and watching.” Usually within two months
there is a complete recovery of the number of platelets.

Decreased platelets in pregnant women

Thrombocytopenia is the second most frequent hematological disorder in
pregnant women (after anemia), occurs in about 10% of women. AT
most cases (70-80%) is physiological (gestational)
thrombocytopenia due to increased volume plasma Number
platelets are usually never lower than 100-75 Chl, and such
the condition does not lead to any adverse outcomes.

Much less often, but there are other causes in pregnant women
thrombocytopenia – ITP, HELLP syndrome, preeclampsia, diseases
костного мозга и others. Decrease in blood platelets in pregnant women
below 75 X / l is dangerous development of bleeding and already requires
treatment.

Low platelet examinations

If thrombocytopenia is accidentally detected and there are no
symptoms are recommended to repeat the analysis with counting cells in a smear
blood under a microscope to eliminate false results.

If the reanalysis confirms reduced platelets in
blood, you need to look for the cause. Algorithm survey from simple to
complex looks like this:

  1. Exclude drugs that may cause
    thrombocytopenia. Repeat analysis a few days after
    cancellation.
  2. If there are other changes in the blood other than low platelets,
    very high or very low leukocytes, anemia, drastic changes
    in leukocyte formula – it is worth immediately suspect pathology
    bone marrow and consult a hematologist.
  3. Biochemical analysis with the study of hepatic enzymes,
    inflammatory proteins, rheumatic factor, coagulogram.
  4. Ultrasound of the liver, spleen, lymph nodes.
  5. Исследование на ATИЧ, вирусные гепатиты, вирус Эпштейна-Бар,
    cytomegalovirus.
  6. Bone marrow puncture and myelogram study.

If after all examinations the cause of the disease is not found,
Idiopathic thrombocytopenic purpura is diagnosed
(ETC).

Basic principles for the treatment of thrombocytopenia

When a diagnosis is established, the treatment of the main
diseases (antiviral treatment in the case of
инфекций, химиотерапия при онкологических состояниях, витамин AT12
with its deficiency, pathogenetic treatment of cirrhosis).

Treatment of isolated thrombocytopenia involves the use of
glucocorticosteroids (prednisolone). In high-risk patients
bleeding (peptic ulcer, hypertension,
pregnancy) treatment begins with a platelet level of 50 X / l. With
a decrease in this indicator below 30 x / l, therapy of the corticosteroids is already shown
all

ATведение иммуноглобулина применяется, если необходимо быстро
raise platelet count (upcoming labor, surgery). Method
limited due to its high cost.

With развитии кровотечения применяется переливание донорских
platelet count.

Another treatment is splenectomy, that is, removal
spleen. Withменяется, если консервативные меры не дают
effect.

If the platelet count is not below the critical level, there is no rash and
bleeding, treatment is usually not prescribed. But:

  • It is recommended to limit lifting weights, working in
    incline.
  • Of the products should eat red meat, fish, eggs,
    greens, liver, beets, carrots, rowan berries, pomegranates, green
    apples, decoction of wild rose.

A blood test must be taken every 3 months.

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