Thrombocytopenia: immune and non-immune - appearance, course, relief, concomitant diseases

Also called Bizzocero plaques, they are fragments of giant bone marrow cells - megakaryocytes. Their number in human blood is constantly fluctuating, least of all they are observed at night. The level of platelets falls in the spring, in women also during menstruation, but it does not go beyond what is permitted, therefore, it is not necessary to speak of thrombocytopenia, as such, in such cases.

With heavy physical exertion, staying in the mountains, taking certain drugs, the amount of these blood cells in the blood, on the contrary, increases.

Platelets that circulate in the blood of a healthy person are biconvex oval or round discs that do not have processes. However, as soon as they find themselves in an unfavorable place, they begin to increase sharply in size (by 5-10 times) and release pseudopodia. These platelets stick together and form aggregates.

Sticking together (platelet factor III) and sticking to fibrin threads, platelets thus stop, that is, they participate in blood clotting.

The first reaction of blood vessels to injury is their narrowing, platelets also help in this process, which, during disintegration and aggregation, release the active vasoconstrictor substance accumulated in them - serotonin.

The important role of blood cells in the coagulation process can not be overestimated, because it is they who form a blood clot, make it dense, and formed reliable, so it becomes clear why the inferiority of platelets and their reduced number attracts such close attention.

What are the clinical manifestations of low platelets?

One of the important characteristics of platelets is their half-life, which is 5-8 days. To maintain a constant level of blood cells, the bone marrow must replace 10-13% of the platelet mass daily, which is ensured by the normal functioning of hematopoietic stem cells. However, in some cases, the number of platelets can decrease not only below acceptable limits, but also reach critical numbers, causing spontaneous bleeding (10-20 thousand per µl).

Symptoms of thrombocytopenia are hard to miss, so the appearance of:

1. Hemorrhages in the skin and mucous membranes (, ecchymosis) that occur spontaneously (mainly at night) or after microtraumas, where insignificant damage can cause significant hemorrhage;
2. Meno- and metrorrhagia;
3. (in rare cases - ear) and gastrointestinal bleeding, which quickly lead to anemia

are characteristic signs of platelet disorders.

Why does the platelet level drop?

The causes of thrombocytopenia are due to various pathological processes in the body and can be represented in four main groups.

I group

thrombocytopenia, associated with insufficient education themselves platelets in the bone marrow which happens under the following conditions:

• Aplastic, when the maturation of cells of all three germs is inhibited - megakaryocytic, red and myeloid (panmyelophthisis);
• Metastases of any tumor in the bone marrow;
• Acute and chronic;
• Megaloblastic anemia (deficiency of vitamin B12, folic acid), however, this case is not a particular problem, since the number of platelets decreases slightly;
• Viral infections;
• Taking certain medications (thiazides, estrogens);
• The consequences of chemotherapy and radiation therapy;
• Alcohol intoxication.

II group

thrombocytopenia, caused by massive bleeding or increased destruction of platelets.

III group

Thrombocytopenia due to pool allocation violation platelets with their excessive accumulation in the spleen (severe splenomegaly).

IV group

Increased destruction of blood plaques without adequate compensation their bone marrow characterizes consumption thrombocytopenia, which can be called:

• Hypercoagulation that occurs when;
• adults and children (immune and non-immune);
• Long-term use of heparin, gold, quinidine;
• Respiratory distress syndrome (RDS), which can develop in newborns (severe respiratory failure in premature babies).
• immune disorders;
• Mechanical damage to Bizzocero plaques (use of vascular prostheses);
• The formation of giant;
• Malignant neoplasms;
• Posttransfusion complications.

Relationship: pregnancy - platelets - newborn

Pregnancy, although it is a physiological process, is not constantly present, therefore, what is not characteristic of a “normal” state can happen during such a period of life. This happens with platelets, while their number can both decrease and increase.

Thrombocytopenia during pregnancy is a frequent phenomenon and is mainly due to a shortening of the life of red blood cells. Increasing circulating blood volume(VCC), necessary for additional blood supply, is associated with an increased consumption of platelets, which do not always keep pace with the process of providing blood to the placenta and fetus.

Thrombocytopenia during pregnancy can be caused by accompanying illnesses(coagulation disorders, viral infections, allergies, medications, in particular nephropathy, immune and autoimmune disorders) and malnutrition.

Immune thrombocytopenia during pregnancy is especially dangerous, as it can cause uteroplacental insufficiency, the consequence of which is often hypotrophy and. In addition, a decrease in platelets can be accompanied by bleeding and even intracerebral hemorrhage in a newborn.

The mother's immune and autoimmune diseases can also lead to violations of thrombocytopoiesis in newborns, which is manifested by a decrease in the number of blood cells and determines such forms of thrombocytopenia:

1. Alloimmune or isoimmune, associated with group incompatibility between the mother and fetus, when maternal antibodies enter the bloodstream of the fetus (neonatal);
2. Iran immune if the woman has idiopathic thrombocytopenia or (antibodies directed against the child's platelets cross the placental barrier);
3. Autoimmune thrombocytopenia, characterized by the production of antibodies to antigens of one's own platelets;
4. Heteroimmune, resulting from exposure to a viral or other agent on the body with a change in the antigenic structure of blood cells.

Decreased platelets associated with immunity

Immune thrombocytopenia includes such forms as:

• Isoimmune or alloimmune - may be neonatal or occur during a blood transfusion that is incompatible in group affiliation;
• Hapten or heteroimmune (hapten - part of the antigen), resulting from the ingestion of a foreign antigen (viruses, drugs);
• Autoimmune thrombocytopenia is the most common and frequently encountered. A breakdown in the immune system, the nature of which, as a rule, is not established, leads to the fact that the immune system ceases to recognize its native healthy platelet and takes it for a “stranger”, which in turn reacts by producing antibodies against itself.

Hemorrhagic diathesis in AITP

Autoimmune thrombocytopenic purpura (AITP) is the most common form of immune thrombocytopenia. It often affects young women (20-30 years old).

A drop in platelet levels that accompanies another disease and is part of its symptom complex is called secondary thrombocytopenia. As a symptomatic, thrombocytopenia is observed in various pathologies:

1. collagenosis (systemic lupus erythematosus (SLE), scleroderma, dermatomyositis);
2. Acute and chronic leukemia (, Waldenström's macroglobulinemia);
3. Chronic hepatitis and kidney disease.

However, AITP, which is called essential or idiopathic thrombocytopenia ( Werlhof's disease), occurs much more often as an independent isolated disease.

This form is called idiopathic due to the fact that the cause of its occurrence remains unclear. With this pathology, platelets do not live on average for 7 days, but for 2-3-4 hours, despite the fact that the bone marrow initially continues to produce all cells normally. However, a constant shortage of blood cells makes the body still react and increase platelet production several times, which negatively affects the maturation of megakaryocytes.

In pregnant women, essential thrombocytopenia has a rather favorable course, but an increase in the frequency of miscarriages is still observed. Treatment of thrombocytopenia in such a case is carried out by administering prednisolone 5-7 days before delivery. The issue of obstetrics is solved on an individual basis, but more often they resort to surgery (caesarean section).

The therapeutic effect of corticosteroids is not necessarily used during pregnancy, they are used in other cases. In addition, a positive effect was seen from intravenous administration of immunoglobulin, which reduces the rate of phagocytosis. True, with repeated relapses of the disease, splenectomy (removal of the spleen) is often preferred.

Immune thrombocytopenic purpura in children and other types of ITP

Acute AITP in children is observed at the age of 2-9 years and occurs 1-3 weeks after a viral infection. Against the background of complete well-being, petechiae and purpura suddenly appear in a child. For such a condition, a characteristic blood picture is thrombocytopenia, and there is no decrease in the level of white blood cells ().

The pathogenesis of this disease is based on the production of antibodies against antigens of viral proteins.. In this case, viral antigens or whole antigen-antibody immune complexes are adsorbed on the platelet membrane. Since the viral antigens still have to leave the body, which in most cases happens, the disease goes away on its own within two to six weeks.

Other forms of immune thrombocytopenia include a rare but serious disease called - post-transfusion purpura. Its development is based on a blood transfusion of a donor transferred about a week ago, positive for one of the platelet antigens, which the recipient did not have. Such a violation is manifested by severe refractory thrombocytopenia, anemia and bleeding, which often lead to intracranial hemorrhage, leading to the death of the patient.

Another significant type of immune thrombocytopenia is due to the interaction of the drug and a component of the platelet membrane - one of the glycoproteins, where the drug or glycoprotein, or their complex may be immunogenic. A frequent cause of the development of immune thrombocytopenia may not even be the drug itself, but its metabolite. This is the nature of heparin-induced thrombocytopenia. Quinine and quinidine are also typical agents capable of inducing pathology. It is interesting that such a reaction to some (specific) drugs is genetically based, for example, taking gold-containing products stimulates the formation of antibodies to platelets.

Non-immune thrombocytopenia

Non-immune thrombocytopenia occupy approximately a fifth of the entire mass of diseases associated with a decrease in the level of blood cells, and are due to:

• Mechanical trauma of platelets (hemangiomas, splenomegaly);
• Inhibition of proliferation of bone marrow cells (aplastic anemia, chemical or radiation damage to myelopoiesis);
• Increased consumption of platelets (DIC, deficiency of vitamin B12 and folic acid).

Besides, non-immune thrombocytopenia observed in some forms of acquired hemolytic anemia, where the most significant are two forms consumption thrombocytopenia:

1. Thrombotic purpura (TTP);
2. Hemolytic-uremic syndrome (HUS).

A typical feature of these diseases is the deposition of hyaline thrombi formed as a result of spontaneous aggregation platelets, in terminal arterioles and capillaries.

Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are thrombocytopenias of unknown origin and are characterized by an acute onset of the pathological process that accompanies severe thrombocytopenia and hemolytic anemia, fever, severe neurological symptoms and renal failure, which can lead to to death.

Thrombotic thrombocytopenic purpura more characteristic of adults and occurs after a bacterial or viral infection, immunization, is often observed in HIV-infected patients, and can also appear during pregnancy, when taking oral contraceptives or when administering anticancer drugs. Cases of development of TTP as a hereditary disease are known.

Hemolytic uremic syndrome more common in children. The cause of this condition is the microorganisms Shigella dysenteriae or enterotoxic Escherichia coli, which destroy the endothelial cells of the renal capillaries. As a result, a large number of von Willebrand factor multimers are sent to the vascular bed, which leads to platelet aggregation.

The first manifestation of this pathology is bloody diarrhea caused by the above microorganisms, and then develops acute renal failure(formation of hyaline thrombi in the vessels of the kidneys), which is the main clinical sign of the disease.

Treatment of thrombocytopenia

Sharp forms

Thrombocytopenia in the acute period should be treated in a hospital, where the patient is hospitalized. Strict bed rest is prescribed until the physiological level (150 thousand per μl) of platelets is reached.

At the first stage of treatment, the patient is prescribed corticosteroid drugs, which he takes up to 3 months, removal of the spleen, if there is no choice, is planned at the second stage, and the third stage of treatment is provided for patients after splenectomy. It consists of the use of small doses of prednisolone and therapeutic plasmapheresis.

Avoid, as a rule, intravenous infusions of donor platelets, especially in cases immune thrombocytopenia because of the risk of aggravating the process.

Platelet transfusions give a remarkable therapeutic effect if they are specially selected (just for this patient) according to the systemHLA However, this procedure is very time-consuming and inaccessible, therefore, with deep anemization, it is preferable to transfuse the thawed washed erythrocyte mass.

It should be remembered that drugs that disrupt the aggregation ability of blood cells(aspirin, caffeine, barbiturates, etc.) are prohibited for patients with thrombocytopenia, about which, as a rule, the doctor warns him when he is discharged from the hospital.

Further treatment

Patients with thrombocytopenia require further follow-up with a hematologist after discharge from the hospital. The patient, who needs sanitation of all foci of infection and deworming, is given them, informing him that SARS and exacerbation of concomitant diseases provoke an appropriate reaction of platelets, therefore, hardening, physiotherapy exercises, although they should be mandatory, are introduced gradually and carefully.

In addition, patient management food diary, where nutrition is carefully planned for thrombocytopenia. Injuries, overload, uncontrolled intake of drugs and foods harmless at first glance, can provoke a relapse of the disease, although the prognosis for it is usually favorable.

The diet for thrombocytopenia is aimed at eliminating allergenic products and saturation of the diet with B vitamins (B12), folic acid, vitamin K, which is involved in the process of blood clotting.

Appointed while still in the hospital, you should continue at home and do not get carried away with eggs, chocolate, green tea and coffee. It is very good to remember at home about folk remedies for combating thrombocytopenia, so herbs with hemostatic properties (nettle, shepherd's purse, yarrow, arnica) should be stored in advance and used at home. Infusions of complex herbal preparations are very popular. Even official medicine recommends them. They say it helps a lot.

Video: thrombocytopenia and hemorrhagic syndrome

In the second half of the term, doctors may detect thrombocytopenia during pregnancy. Not always a decrease in platelet levels is dangerous for a woman in position.

However, in some cases, thrombocytopenia can be a sign of serious illness, so when it is detected, additional diagnostics are usually carried out.

Thrombocytopenia can occur in anyone at any age. What is thrombocytopenia and why is it dangerous?

There are many different blood cells in human blood, each of which performs specific functions.

Platelets are responsible for blood clotting: when injured, they are involved in the creation of fibrin clots that clog the wound and stop bleeding.

In addition, platelets help blood vessels maintain elasticity and strength.

Platelets are born in the bone marrow, after entering the bloodstream they live on average for about a week. At the end of their lives, platelets are broken down in the spleen or liver.

An insufficient number of platelets is referred to as thrombocytopenia. This pathology is often observed in pregnant women.

It is detected with a simple blood test, which pregnant women take several times during the entire period of bearing a child.

Most often, thrombocytopenia does not need treatment, as it is a natural reaction of the body to hormonal changes and disappears by the end of pregnancy.

A normal indicator for pregnant women is 150 * 10 9 platelets per 1 liter of blood. If this indicator falls below the value of 140, then doctors diagnose thrombocytopenia.

In most cases, thrombocytopenia is found in the middle or late pregnancy. Pathology can be caused by many factors, and the task of doctors is to determine what caused thrombocytopenic disease.

If the number of platelets in the blood of a pregnant woman drops to - 20-40 * 10 9, then an artificial increase in the level of platelets is necessarily prescribed.

The lack of cells responsible for blood clotting can lead to dangerous consequences, including the death of the fetus or mother during childbirth.

In addition, some types of thrombocytopenia (especially immune) can be transmitted to the fetus. Therefore, it is important to prevent the development of this pathology in pregnant women to a critical level.

Causes of thrombocytopenia in pregnant women

Most often, a decrease in the number of platelets in the blood of pregnant women is due to hormonal changes throughout the woman's body.

Since the process of hematopoiesis undergoes changes, early destruction of platelets is possible, which should not bother either the pregnant woman or the doctors.

Insufficient production of red blood cells is also not always recognized as dangerous. Such cases generally do not require the intervention of doctors - they are simply observed throughout the entire period of pregnancy.

The physiological causes of thrombocytopenia are not harmful: they last for a short time, and after their end, the platelet level returns to normal.

Physiological reasons include:

• hypothermia or heat stroke;
• great physical activity;
• stress;
• being in an area of ​​high pressure.

There are also reasons that may indicate any violations in the body of a pregnant woman.

These reasons cannot be ignored, therefore, when thrombocytopenia is detected in pregnant women, doctors immediately begin to diagnose and treat them.

Adverse factors affecting the development and intensification of thrombocytopenia during pregnancy are:

• an increase in the content of blood plasma and, as a result, a decrease in the percentage of red blood cells;
• viral and infectious diseases;
• the development of allergies;
• folate deficiency or iron deficiency anemia;
• disruption of the vessels in the kidneys or placenta;
• severe form of toxicosis (eclampsia);
• bleeding due to placental abruption;
• poisoning;
• excessive use of drugs (antibiotics, heparins, sulfonamides, acetylsalicylic acid, etc.);
• death of the fetus inside the womb;
• disruption of the immune system, when antibodies take platelets for harmful elements and destroy them;
• disturbances in the work of the red bone marrow.

A moderate lack of platelets in pregnant women does not require its artificial increase. Most often, the correct solution is to eliminate the cause of thrombocytopenia.

Signs of thrombocytopenia

In a pregnant woman, thrombocytopenic disease does not always manifest itself. Its mild form (100 - 140 * 10 9 / l) can be asymptomatic and can be detected only as a result of a blood test.

In cases where thrombocytopenia in pregnant women has low rates (less than 100 * 10 9 / l), various symptoms may appear that are associated with poor blood clotting.

If the following symptoms appear in a pregnant woman, then they should be reported to the doctor as soon as possible.

First of all, a pregnant woman suffers from frequent nosebleeds, which are very plentiful, and it is difficult to stop them.

The causes of nosebleeds can be minor injuries (strong pressure on the wing of the nose, sudden movement or tilt, sneezing, coughing). Sometimes nosebleeds appear for no reason at all.

Bleeding gums can also indicate thrombocytopenia during pregnancy. Do not confuse bleeding gums with thrombocytopenia with gingivitis, which often occurs in pregnant women.

It is not uncommon for a pregnant woman with thrombocytopenia to have spots or a reddish rash on her skin.

The spots look like ordinary hematomas, have different shapes and colors. Appear as a result of touch or for no reason.

Hemorrhagic rash is a small red spots that cover the arms or torso of a pregnant woman.

They indicate internal subcutaneous hemorrhages and are not accompanied by any unpleasant sensations (itching or pain).

In pregnant women with thrombocytopenia, internal bleeding is possible - gastric, renal, intestinal.

They appear in the taste of iron in the mouth or blood clots in the stool. These clots are reddish to almost black in color. Renal bleeding can be expressed by the presence of blood in the urine of a pregnant woman.

Uterine bleeding is considered a particularly alarming symptom of thrombocytopenia during pregnancy. If it occurs, you should immediately consult a doctor.

Treatment and prognosis

In most cases, thrombocytopenia during pregnancy does not require special treatment. If the cause of its occurrence lies in a change in the hormonal background, then doctors do not intervene during pregnancy, limiting themselves to recommendations on the nutrition of the expectant mother.

Compulsory treatment is subject to autoimmune thrombocytopenia and thrombocytopenia, characterized by an extremely low platelet count (below 40*10 9 /l).

Autoimmune thrombocytopenia is dangerous because the mother's antibodies can get into the blood of the fetus and cause thrombocytopenia in the newborn.

Therefore, doctors prescribe treatment with immunoglobulins, which are administered several times during the last months of pregnancy, then once during childbirth and once after childbirth.

To determine thrombocytopenia in a newborn, blood is taken from the umbilical vein, from the mother and from the baby himself.

If the level of platelets is critically low, then the pregnant woman is prescribed glucocorticosteroids. In severe cases, the administration of a platelet mass may be required.

Sometimes removal of the spleen in the second trimester may be necessary. Splenectomy is performed in cases where drug treatment is ineffective.

Thrombocytopenic disease during pregnancy does not have serious consequences if the pathology proceeds under the supervision of specialists.

During childbirth with thrombocytopenia, mechanical manipulations with the fetus (use of forceps, vacuum extraction, etc.) are prohibited in order to prevent hemorrhage in the child's brain.

In a woman during childbirth, obstetricians and gynecologists should not allow profuse blood loss.

In some cases (especially if there is a possibility that the fetus also has thrombocytopenia), doctors recommend a caesarean section.

Every woman during pregnancy should undergo regular examinations, in particular, take a general blood test. This will allow timely detection of abnormalities and diagnose diseases that are life-threatening for the mother and child. An important indicator in the results of the study is the number of platelets.

What are platelets

Platelets are thin blood discs that have the unique ability to clot blood. In the event of wounds or cuts, they stick together, forming clots that clog blood vessels and prevent blood loss. As a result of this process, a crust forms on the surface of the skin, upon removal of which bleeding can resume.

In addition to participating in blood clotting, platelets help protect the body from attacks by harmful viruses and bacteria. They are actively involved in the formation of immunity and are constantly updated.

The period of life of platelets is no more than one week. Old cells are destroyed in the spleen, giving way to new blood discs.

Norms during pregnancy

The level of platelets is determined by taking a general blood test. During pregnancy, their number decreases due to an increase in blood volume and the appearance of a placental circulation. The norm for expectant mothers is considered to be from 140 to 340 thousand / μl.

So, in the third trimester of pregnancy, the content of platelets in the blood reaches a minimum level. At the same time, immediately before childbirth, the activity of these cells increases sharply, due to which the fluidity and viscosity of the blood are maintained at the required level until the very birth.

After the birth of a child, changes occur in the woman's blood aimed at minimizing blood loss by increasing blood clotting. By the end of the postpartum period, the indicators return to their original state.

It happens that in the process of carrying a child, the platelet count in the blood deviates from normal values.

1. If there are too many of these cells, then there is a danger of blood clots.
2. Decreased platelet count increases the risk of bleeding.

The quantitative content of platelets is determined by a general blood test, but there are situations when this indicator does not go beyond the normal range, but violations are still present. In such cases, a coagulogram helps. A very important indicator is platelet aggregation. Normally, this figure is 30-60%. With its deviations to the smaller side, bleeding can occur, while an increased level of aggregation leads to the formation of blood clots.

Norms of platelets in the blood depending on the trimester of pregnancy - table

Decreased platelet count

A low level of platelets, or thrombocytopenia, occurs when the blood levels of these cells fall below 140,000/mcL.

Causes

The causes of thrombocytopenia include the following factors:

• allergies;
• intoxication and viral infections;
• deficiency of vitamins and minerals in the body;
• anemia caused by a lack of folic acid or vitamin B12;
• late gestosis in severe form;
• excess or deficiency of thyroid hormones;
• bleeding, including internal;
• disorders in the work of the kidneys;
• failure of the coagulation system;
• bone marrow hypoplasia;
• oncological diseases affecting the bone marrow;
• chronic hepatitis;
• thrombocytopenic purpura;
• taking medications that affect the composition of the blood (diuretics, painkillers, antiallergic and antirheumatic drugs, some antibiotics, Quinine, etc.).

Symptoms

Thrombocytopenia is detected using a general blood test and a coagulogram, although a problem can already be suspected on the basis of a number of external factors:

• hematomas constantly form on the body - often due to simple pressure with a finger;
• on the skin you can notice a rash, which is a cluster of small hemorrhages;
• there is bleeding gums;
• spontaneous nosebleeds often occur;
• when cut, the blood does not stop for a long time;
• the stool becomes too dark, indicating internal bleeding;
• bloody discharge comes from the vagina.

External signs of thrombocytopenia - gallery

Treatment

Medical appointments depend on which form of thrombocytopenia is established.

1. In the case of a viral disease, the platelet count returns to normal on its own after the infection is adequately treated.
2. If the problem is provoked by taking any medications, then it is enough to stop using these drugs.
3. In case of problems with the kidneys, liver or thyroid gland, normalization of the work of these organs is necessary.
4. • fresh vegetables, berries and fruits (bananas, apples, etc.);
   • eggs, legumes and mushrooms - perfect for replenishing iron deficiency;
   • fish, meat, liver - rich in vitamin B12;
   • greens and nuts - contain folic acid. If the reason is a lack of vitamins, then the situation is easily corrected with a diet. Expectant mothers should exclude smoked meats, canned food and foods that contain citric or acetic acid from their diet. Pregnant women are advised to consume in sufficient quantities:
5. With an autoimmune variety of the disease, when the body produces antibodies that destroy platelets, treatment will include:
   • taking corticosteroid drugs;
   • dieting;
   • the use of angioprotectors and immunoglobulins;
   • blood transfusion (prescribed in severe cases, when the platelet level is below 20 x 10 ^ 9 / l, and medications do not give the desired effect or their intake is impossible for medical reasons).

Thrombocytopenia is very dangerous, especially for pregnant women, therefore, at the first signs of this disease, you should immediately contact a hematologist and follow all his instructions. Treatment is usually not aimed at increasing the level of platelets, but at eliminating the causes that caused this condition.

Products prohibited in thrombocytopenia - gallery

Hematologist about the reasons for the decrease in platelets - video

Elevated platelets

An increased content of platelets in the blood, or, is diagnosed when the number of these cells exceeds the level of 400 thousand / μl.

Note! A slightly elevated platelet level during pregnancy may be a physiological phenomenon: this is how the body prepares for childbirth, trying to reduce future blood loss. If the platelet count is only slightly higher than normal and no alarming symptoms are observed, this condition does not need to be treated.

Causes

In the early stages of pregnancy, blood clots can occur as a result of manifestations of toxicosis: frequent vomiting or diarrhea. In the second and third trimesters, thrombocytosis can have the following causes:

• profuse sweating and limited fluid intake;
• viral, bacterial or fungal infections;
• inflammatory diseases, including chronic ones;
• Iron-deficiency anemia;
• big loss of blood;
• oncological diseases of the blood and internal organs;
• taking certain medications (diuretics, steroid hormones, etc.)

Hidden iron deficiency in iron deficiency anemia:

Symptoms

Symptoms of thrombocytosis largely repeat the signs of thrombocytopenia. This is due to the fact that in both cases, blood cells are unevenly distributed in the vessels and do not cope well with their functions, which leads to such manifestations as:

• the occurrence of hematomas even with weak exposure;
• rash in the form of small hemorrhages;
• bleeding from the nose and gums;
• dark chair;
• too pale skin and mucous membranes;
• tingling and numbness in the tips of the fingers and toes;
• prolonged bleeding even from small cuts and wounds;
• high or low blood pressure;
• headache;
• dyspnea.

Treatment

In the treatment of thrombocytosis, a hematologist prescribes drugs that thin the blood and normalize its composition: anticoagulants and antiaggregants. The dosage of drugs is selected individually (taking into account the degree of violations and the risk to the fetus).

In addition, a pregnant woman needs to follow a certain diet. The diet of the expectant mother should include the following products:

• vegetable oil (especially linseed and olive);
• fish fat;
• garlic;
• tomato juice;
• sour berries and fruits;
• foods containing iodine, calcium and magnesium: green vegetables, avocados, persimmons, kefir, cottage cheese, buckwheat, rice bran, caviar, and seafood.

But bananas, chokeberries, lentils and walnuts should be excluded from the diet, as they have the ability to thicken the blood.

With thrombocytosis, pregnant women should carefully observe the drinking regimen, drinking at least 2 liters of fluid daily: pure water, green tea, acidic drinks, etc.

Many people prefer to thin or thicken the blood with traditional medicine. However, such herbal decoctions and infusions are good for men and non-pregnant women. It is better for future mothers not to use them, since it is rather problematic to calculate the correct dosage of medicinal plants at home, and some herbs adversely affect the fetus and uterine tone.

Foods Recommended for Mild Platelet Elevation - Gallery

Seafood contains iodine, which lowers platelet counts. Green vegetables are high in calcium and magnesium.

Reduction of platelets in the blood to the minimum values ​​in medicine is called thrombocytopenia. Most often, the pathology is observed during pregnancy and childbirth.

Thrombocytopenia during pregnancy can cause bleeding, both in the fetus and in the mother herself.

The causes of thrombocytopenia can be associated with both hereditary and acquired factors. Most often fix idiopathic thrombocytopenic purpura.

During pregnancy, the number of platelets is significantly lower than normal. The norm in healthy people is 150.0-400.0 109/l.

In connection with the reasons for the development and course of the disease, it is customary to divide thrombocytopenic purpura into the following types:

1. Acute (drug, infectious, allergic, concomitant diseases, the appearance of repeated blood transfusions in newborns during pregnancy).
2. Chronic (symptomatic and autoimmune).

Reasons for development

The causes of thrombocytopenia do not have an exact evidence base. Pregnancy, viral infections, stress, surgical operations, immune disorders serve as a factor and impetus for development.

Symptoms

Symptoms of thrombocytopenia during pregnancy are expressed by hemorrhages in the skin. They appear suddenly, even in cases of slight bruising. Progressing, they can cause bleeding from the mucous membranes of the nose or gums.

Hemorrhages under the skin can have a different shade (red, blue, yellow) and size. Most often, such hemorrhages are fixed on the front of the limbs and torso. Sometimes they appear on the face and oral mucosa.

Why is thrombocytopenia dangerous for pregnant women and what are the consequences?

Thrombocytopenic purpura does not affect fertility (the ability to get pregnant). However, there is a high risk of abortion, toxicosis and complications (preeclampsia). There are frequent cases of premature birth.

Extensive bleeding that can occur during childbirth is life threatening. There is a risk of thrombocytopenia in the newborn.

Treatment of thrombocytopenia

Treatment of thrombocytopenia during pregnancy begins with a thorough diagnosis. Diagnosis and detection of pathology is based on a complete history, examination of the patient and the appointment of tests. It is important at this point to exclude other diseases.

The treatment regimen for idiopathic thrombocytopenic purpura depends on the stage of the course of the disease and the number of platelets.

With a mild form, during pregnancy, treatment is not applied. Shown only the observation of a doctor and monthly monitoring of blood tests. It is recommended to change jobs with harmful working conditions. In other cases, when the number of platelets is underestimated, general therapy is prescribed. Drug therapy (glucocorticoids) is used.

In Russia, prednisolone is often prescribed, in short courses with a gradual dose reduction. In cases of resistance (body resistance) to prednisolone, immunoglobulin (intravenously) may be prescribed.

Treatment of thrombocytopenia with folk remedies involves herbal medicine. Use tinctures of wild rose and nettle.

Pregnant women with bleeding and platelet count less than 20.0 ・ 109/L should be hospitalized. Such patients receive increased doses of glucocorticoids.

With the threat of a large loss of blood, a laparoscopic splenectomy is prescribed.

With the onset of pregnancy, a woman's body undergoes internal changes. The endocrine system enters the battle for the well-being of the baby, increasing the production of hormones. Meanwhile, such care often harms expectant mothers. However, during this period, women rarely pay attention to their own health, enduring hardships for the sake of the health of the unborn baby.

It is during pregnancy that women have to deal with a variety of ailments, which in their normal state they would hardly have been able to “meet”. One of them is thrombocytopenia or thrombocytopenic purpura.

It should be noted that thrombocytopenia during pregnancy occurs quite often. Therefore, every woman who is preparing to become a mother should know what factors can provoke the development of this disease, how to recognize it, and what methods of treatment are used during pregnancy to eliminate this ailment.

general description

Seeing only the name of this disease, it becomes clear that thrombocytopenia causes problems with platelets. Indeed, thrombocytopenic purpura develops if the level of platelets in the blood decreases. But in order to understand how dangerous this condition is for pregnant women, one should understand the functions of platelets.

The red brain is the main organ of hematopoiesis, which forms special cells called megakaryocytes. When they are destroyed, platelets are formed. Normally, each liter of human blood contains about 300 * 109 platelets. At the same time, many factors influence their number, for example, sleep, menstruation or stress.

The lifetime of each platelet does not exceed 7 days, after which they are disposed of by the spleen. In its absence, the function of the cleaner is performed by the liver.

Platelets are covered with a membrane containing special molecules that can find and recognize damage in the vessels. When the slightest damage occurs, platelets quickly approach the site of damage and stick together, thus plugging the hole in the vessel. In addition, platelets increase blood clotting and help stop bleeding, forming a platelet plug at the site of injury.

Based on the foregoing, we can conclude that platelets perform a protective function, preventing. Also, these tiny cells nourish the walls of blood vessels, increasing their elasticity and resistance to external influences.

If for some reason the production or utilization of platelets is disturbed, a person develops thrombocytopenia, which, in fact, is low blood clotting. This condition can also be caused by an uneven distribution of cells in the vascular bed. That is, they can accumulate in one place, and in other places their deficit will be felt.

Reasons for the development of the disease

Thrombocytopenia during pregnancy develops in 2% of women. Although scientists have not been able to establish the exact cause of this phenomenon, they have identified several factors that can provoke the development of this pathology. These include:

• hormonal imbalance that reduces the life span of platelets;
• a decrease in the number of platelets during pregnancy is possible due to an increase in blood volume;
• deficiency of nutrients and vitamins in the diet of pregnant women;
• impaired renal function;
• preeclampsia and eclampsia;
• infectious diseases of viral etiology;
• dysfunction of the immune system, causing the development of autoimmune thrombocytopenia;
• uterine bleeding not associated with menstruation, for example, with placental abruption;
• frozen pregnancy;
• taking certain medications;
• general intoxication of the body.

Thrombocytopenia may be primary or secondary. At the same time, secondary thrombocytopenia in pregnant women develops against the background of poisoning with various toxic substances or taking certain medications.

If the platelet count drops to 100*109, the woman is diagnosed with physiological thrombocytopenia. This condition does not threaten the life and health of the future mother and fetus. However, in this case, the woman should be under the special supervision of a doctor and control the level of these cells through testing.

In order to avoid serious consequences in the event of a pathological decrease in the level of platelets, it is necessary to establish which pathological processes provoked the development of this condition, and immediately begin treatment.

Signs of the disease

In the normal state, a decrease in blood clotting, as a rule, is detected during a mandatory medical examination. However, in pregnant women, this condition is accompanied by specific and non-specific signs. Specific features include the following:

• causeless appearance of bruises on the skin;
• nose and uterine bleeding;
• gastrointestinal bleeding;
• the appearance of a red rash on the trunk and limbs, representing small punctate hemorrhages.

One of the non-specific signs is bleeding gums. However, women pay little attention to this condition, since gingivitis is a common occurrence during pregnancy.

Methods for diagnosing thrombocytopenia

When signs of thrombocytopenia appear, the doctor conducts a comprehensive examination that allows you to confirm or exclude this disease.

The list of diagnostic measures includes the following:

• questioning the patient for hereditary thrombocytopenia;
• general inspection;
• a general blood test to determine the number of platelets in the blood;
• bone marrow aspiration biopsy.

Thrombocytopenia during pregnancy is determined through a laboratory blood test, which is the most informative diagnostic method. If there are clear signs of the disease on the woman's body, the doctor may prescribe an aspiration biopsy of the bone marrow.

The predominance of a high content of megakaryocytes in the seized material indicates an increased activity of the spleen, which destroys platelets. The method of treating this pathology is determined based on the general condition of the expectant mother and her child.

Why is thrombocytopenia dangerous?

If you ignore the signs of the disease and do not treat it, there is a high probability of developing complications that can occur both during pregnancy and during childbirth. The greatest danger is massive bleeding, which can result in the death of the woman in labor.

If the development of thrombocytopenia is caused by autoimmune processes, there is a risk of antibodies penetrating the placenta and entering the blood of the unborn baby. In this case, neonatal thrombocytopenia develops.

The way the baby is born is determined by the doctor. It is not contraindicated for women to give birth in a natural way only if the platelet level does not drop to a critical level equal to 40 * 109.

At the same time, it is contraindicated to carry out any obstetric operations involving the removal of the fetus during labor or blood sampling, since in this case the risk of intracranial hemorrhage increases significantly.

Immediately after birth, cord blood is taken from these children to determine the level of platelets. If their number approaches a critical point, immunoglobulin is administered to babies, and, if necessary, platelet masses.

Treatment of thrombocytopenia

Thrombocytopenia, as a rule, develops in the last trimester of pregnancy, when the probability of getting autoantibodies through the umbilical cord into the blood of the fetus increases significantly. Therefore, if the diagnosis is confirmed, the woman is immediately prescribed treatment.

If the level of platelets is critically low, a woman is placed in a hospital, where the cause of thrombocytopenia is determined and measures are taken to maintain homeostasis.

Conservative treatment involves glucocorticosteroids, which include Dexamethasone and Prednisolone. If these drugs have not had the desired effect, intravenous immunoglobulin is shown to expectant mothers. This drug is administered 3-4 times, first during pregnancy, then during childbirth and the last time immediately after delivery. In some cases, platelet masses are administered to women.

If none of the possible conservative methods of treatment has brought positive results, the expectant mother undergoes a surgical operation, during which the spleen is removed. To minimize the negative impact on the fetus, abdominal surgery is replaced by laparoscopic surgery.

Both conservative and surgical treatment of thrombocytopenia do not affect the condition of the pregnant woman and the unborn child. Therefore, the prognosis for complete recovery is positive.

Prevention of thrombocytopenia

Every woman during pregnancy should regularly visit a doctor, take tests on time and take the prescribed treatment. This will help to avoid the development of gestosis (late toxicosis), against which gestational thrombocytopenia can occur.

However, the main preventive measures are aimed at preventing infection with viral infections that have a negative impact on the immune system. It is viruses that most often cause the development of autoimmune processes.

In addition, viruses entering the body release waste products that cause severe intoxication. Intoxication, in turn, inhibits the function of the red brain, resulting in a decrease in platelet production.