Thrombocytopenia is a decrease of platelets in the blood (less than 150 G / l) with a risk of serious bleeding and unpredictable when the rate is less than 50 G / l.
Various reasons can be the cause of this decline: causes peripheral destruction or consumption sequestration in the spleen (hypersplenism) platelets and central causes in hematological malignancies with impaired platelet production.
If the platelet count is between 70 and 150 G / l, without any symptoms associated with clinical or haematological it can be a pseudo-thrombocytopenia. In this case, no further investigation is necessary, especially if the platelet control remains stable after 3 months after this discovery and, in the continued absence of any clinical or hematological malignancies.
For thrombocytopenia original devices, two etiologies dominate: immunoallergic thrombocytopenia with heparin which are very common and warrant close monitoring of patients treated with this drug to prevent the risk of phlebitis and autoimmune thrombocytopenic purpura.
Risk factors are multiple.
The elderly, patients treated for autoimmune disease (systemic lupus erythematosus, scleroderma, rheumatoid arthritis, auto-hemolysis immmune) for hypertension and patients taking anticoagulants or antiplatelet and subjects with acquired deficiency or congenital coagulation factors are most at risk for thrombocytopenia.
Peripheral viral thrombocytopenia is seen especially in children and young subjects, sometimes after an infectious episode unnoticed (measles, rubella, varicella) or more often after infectious mononucleosis, cytomegalovirus infection or HIV. In general, thrombocytopenia most often corrects itself spontaneously, sometimes 1-2 months.
The drug-induced immunoallergic thrombocytopenia is seen particularly with drugs that contain quinidine treatment with blood pressure containing a thiazide. It regresses within 8 days after stopping the drug. Besides, thrombocytopenia caused by treatment with heparin (prescribed prevention of phlebitis) or they appear within 5 days and they are benign, they appear to be from 7 th day and then they are in serious because risk of arterial thrombosis.
Finally, the diagnosis of idiopathic thrombocytopenic purpura (ITP) is mentioned after elimination of other causes of thrombocytopenia. The treatment is based on taking corticosteroids and in resistant forms (rare), the use of monoclonal antibodies, immunosuppressive drugs, immunoglobulins (especially in children).
Primarily an unexplained bleeding.
Any unexplained bleeding must perform a complete blood count looking for abnormal blood and especially thrombocytopenia, either nosebleeds after the occurrence of hematoma after an injection of conjunctiva abnormal (“red-eye “) or rules of unusually heavy or neurological disorders.
The “red spots” on the skin, bleeding from the mouth without obvious cause also encourage search thrombocytopenia.discovery of a large spleen (splenomegaly) clinical examination by the physician is also an incentive to practice hemogram. Finally, the occurrence of even minor bleeding after taking medications, especially prescribed for prevention of phlebitis or hypertension, is a circumstance which justifies the search of splenomegaly.
A blood test to search for low platelets
The blood (or blood count) to determine low levels of platelets, resulting in thrombocytopenia.
This can occur with or without other cellular abnormalities on white blood cells or red.
According to the clinical setting and confirmation of thrombocytopenia in medical analysis laboratory, a coagulation may be asked to research eg DIC, a hemolytic uremic syndrome.
In suspected cases of thrombocytopenia by a central mechanism, a myelogram is then performed (under local anesthesia) to remove a malignant blood disease, bone marrow failure, metastases.
Treatment of thrombocytopenia depends on the cause and mechanism (central, peripheral).
Platelet transfusion is usually reserved for central mechanisms falls with inadequate platelet production by the bone marrow cells, in particular in cases of hematologic malignancy.
Other emergency treatments are based etiologies of peripheral mechanisms: in most cases, to severe thrombocytopenia with risk of bleeding, it is prescribed by hematologists corticosteroids or immunoglobulin administration.
Followed by the hemogram (blood composition analysis) depends on the cause of thrombocytopenia and the evolution of platelets.
This monitoring aims to assess the risk of bleeding associated with increased platelet collapsed. It also aims to measure the effectiveness of any proposed treatment to correct thrombocytopenia concern.
If you have a proven thrombocytopenia (platelets <100 G / l), it is important to report all health professionals may treat you to prevent inappropriate actions that you may cause severe bleeding.
In addition to coming with his latest blood tests during the consultation with the specialist (hematologist in most cases), it is important to make a memory for all unusual clinical manifestations, such as nosebleeds, bruising without obvious cause , repeated infections.
This information is to communicate so that they can assess the severity of thrombocytopenia and your impact in your life.
Also, do not forget to inform the new medication that could cause a change in the rate of platelets.