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In a healthy person, the number of platelets in the blood system depends on the balance between their production and destruction. Disruption of this process leads to a situation in which there are too few or too many platelets in the body. When the body produces platelets too slowly, destroys them too quickly, or when both are running simultaneously, the number of platelets in the blood drops. Then we are talking about thrombocytopenia.
The most common causes of thrombocytopenia are bone marrow diseases (leukemia, lymphomas), metastases of other neoplasms to the bone marrow (prostate cancer, lung cancer), infections with certain viruses (e.g. HIV, HCV, CMV, rubella, mononucleosis), tuberculosis, malaria, Helicobacter infections pylori, taking certain vaccines, taking certain medications, contact with toxins, radiation, and alcoholism.
Thrombocytopenia adversely affects hemostasis and blood clotting. It is also the cause of hemorrhagic diathesis.
According to the definition, correct haemostasis is our body’s defense mechanism, whose task is to prevent the outflow of blood from the vessels. In other words, it is about maintaining proper blood flow in the circulatory system, both when the body’s tissues are damaged and during its proper functioning.
The reactions that take place in the process of hemostasis lead to the formation of a fibrin clot. Four systems are involved in maintaining the hemostatic balance – the blood vessel wall, platelets, the coagulation system and the fibrinolytic system. The blood vessel wall and platelets stop the bleeding mechanically (primary haemostasis). The coagulation system is responsible for the long-term closure of the damaged vessel (final haemostasis). And the fibrinolytic system restores and maintains blood flow by removing excess clot and initiating wound healing. All disturbances in the proper course of haemostasis may lead to symptoms of hemorrhagic diathesis or thromboembolic complications.
Hemorrhagic diathesis
The most numerous group of bleeding disorders are those related to thrombocytopenia. The next one is a defect related to the deficiency of plasma coagulation factors, and the next one is due to vascular changes.
Thrombocytopenic bleeding disorders can be associated with a wide variety of factors, which is why the picture of the disease itself can be heterogeneous. The disease may be due to accelerated destruction of platelets, impaired bone marrow platelet production, or misalignment of platelets.
The spontaneous breakdown of platelets is a pathological process and is associated with the abnormal responses of the immune system. The reduction in platelet production is often caused by hypoplasia (shaping cells of the wrong size) or aplasia (non-formation) of the bone marrow. There are more cases of hypoplasia, which can be triggered by treatment with cytostatics, immunosuppressants, or radiation therapy. Over 150 drugs have been identified, the administration of which may have such side effects. They include not only drugs used in the treatment of neoplastic diseases, but also antidiabetic, cardiac and sedative drugs. Most cases of drug induced thrombocytopenic bleeding disorders occur as a result of the direct influence of toxic substances contained in the drug on the bone marrow. In the case of thrombocytopenia caused by an immune reaction, specific antibodies are formed in the patient’s body – only in the presence of the drug. These antibodies react with the plasma antigen to form an antigen-antibody complex. This complex is absorbed by platelets. These are damaged and eliminated from the circulation.
After drugs such as quinine or quinidine, allergic purpura may appear, which is called selective damage to the plate-forming system. In purpura, the number of platelets in the blood is usually very low, which can result in bleeding in the organs. However, if you stop taking the medication, your platelet count will return to normal within a few days.
Thrombocytopenia can also occur in people who have severe vitamin B12 and folate deficiencies. In order to confirm such deficiencies, tests should be performed and the results discussed with a doctor. Dietary supplements are available without a prescription, but the decision on the legitimacy of their use and dosage should be made by a doctor. Here are some sample products:
- Vitamin B12 Capsules (Compare Prices)
- Folic acid tablets (compare prices)
- Folic acid spray (compare prices)
- Dietary supplement with vitamin B12, vitamin B6 and folic acid (compare prices)
Thrombocytopenia, which is associated with the abnormal distribution of platelets in the vascular system, occurs in diseases where the spleen is enlarged and in the case of liver cirrhosis, splenic vein thrombosis, and the so-called splenic vein thrombosis. hyperplastic syndromes, e.g. in Hodgkin’s disease or malignant non-Hodgkin’s lymphoma.
Symptoms of thrombocytopenia
Regardless of the cause of thrombocytopenia, the symptoms of the disease are the same. These are petechiae, bruises, nosebleeds or gums that worsen even after minor injuries. Another feature of the disease is heavy bleeding with minor injuries or surgery.
Bruises on the skin appear even with slight pressure on the body. Petechiae sometimes spread to large areas of the body. They cover the skin and subcutaneous tissue not only on the limbs but also on the torso. Women may experience profuse vaginal bleeding. Serious complications of thrombocytopenia include gastrointestinal bleeding and intracranial bleeding.
Blood tests are also used to diagnose thrombocytopenia, which show that platelets vary in size and shape. Usually, giant and very small plates can be found. Thrombocytopenia is diagnosed when the platelet count falls below 150 / microlitre.
Treatment of thrombocytopenia
It always depends on the cause of the disease, taking into account the mechanism of the disease. The more information your doctor has obtained from you or your loved ones, the better they will be able to develop a treatment regimen. It is important that in any case of thrombocytopenia, you tell your doctor about the medications you are taking, about contact with toxic substances, past infections or vaccinations. One of the treatment features is the elimination of the patient’s contact with disease-causing factors, e.g. with toxic substances.
In the event of organ bleeding, the patient is given platelet concentrates. Patients are also given corticosteroids because they reduce capillary permeability.
In toxic thrombocytopenia, i.e. a disease caused by the toxic effects of certain drugs or other chemicals, improvement in health, i.e. an increase in the number of platelets, occurs after 3-9 months. The mainstay of treatment is the immediate discontinuation of drugs that have led to the development of thrombocytopenia. To control sudden bleeding, antifibrinolytics are given. The use of routine or vitamin C is not very effective in such cases.
Tekst: Anna Jarosz