Thrombocytosis can be roughly divided into two types, one is secondary thrombocytosis (st) and the other is essential thrombocytosis (ET). This article mainly describes primary thrombocytosis, which is a clonal disease of hematopoietic stem cells dominated by megakaryocyte proliferation, It is characterized by abnormal proliferation of megakaryocytes in bone marrow and significantly increased platelet count. The main clinical manifestations are bleeding and thrombosis.
Classification of primary thrombocytosis
Primary thrombocytosis is also a bone marrow proliferative tumor disease. Bone marrow proliferative tumors (MPN) are a group of diseases characterized by excessive proliferation of hematopoietic stem cells and bone marrow primary or multiple lines (such as granulocyte system, erythrocyte system, megakaryocyte system and mast cells). In the chronic myeloid tumors revised by who in 2008:
1,Change “bone marrow proliferative disease (MPD) into bone marrow proliferative tumor (MPN);
2,JAK2 gene mutation was used as a diagnostic criterion for PV (polycythemia vera), et (primary thrombocytosis) and PMF (primary bone marrow fibrosis);
3,In ET (primary thrombocytosis), the platelet count decreased to > = 450×10 ^ 9 / L;
Bone marrow proliferative tumors (MPN) include nine diseases:
(1) Bcr-abl was positive in chronic myeloid leukemia (CML);
(2) Polycythemia vera (PV);
(3) Primary thrombocytosis (ET);
(4) Primary myelofibrosis (PMF); also known as idiopathic myelofibrosis (IMF);
(5) Chronic neutrophil leukemia (CNL);
(6) Chronic eosinophilic leukemia was not otherwise classified (cel, NOS);
(7) Hypereosinophilic syndrome (HS);
(8) Mast cell disease (MC);
(9) Bone marrow proliferative tumor, can not be classified (MPN, U);
Now common MPN refers to: polycythemia vera (PV), primary thrombocytosis (ET) and primary myelofibrosis (MF).
What are the causes of thrombocytosis?
The etiology of primary thrombocytopenia is not clear.
The common causes of secondary thrombocytosis include infection, acute blood loss, post splenectomy, malignant tumor, anemia and so on.
For example, when the body is stimulated by pathogens (such as bacteria and viruses), the secretion of various cytokines in the body increases, such as interleukin. These cytokines can cause the increase of platelets; another example is ITP (patients with thrombocytopenic purpura) After splenectomy for immune thrombocytopenia, there is a case of thrombocytopenia, which is also called secondary thrombocytopenia, because the spleen has phagocytosis (regular clearance or destruction) after splenectomy The function of platelets to maintain the normal level of platelets. When patients remove the spleen, the phagocytosis and destruction of platelets by the spleen weaken or disappear, and platelets increase. Here I want to tell you that splenectomy should be cautious.
Which type of person is more likely to suffer from primary thrombocytopenia?
Middle aged and elderly people (50 ~ 70 years old) are prone to primary thrombocytopenia. There are also some pathogenic factors:
1,Patients with abnormal bone marrow hematopoietic function
People with abnormal hematopoietic function in bone marrow are more likely to cause abnormal proliferation of hematopoietic stem cells, resulting in excessive proliferation of megakaryocytes in bone marrow, which are the source of platelets in blood, and then primary thrombocytosis.
2,History of related diseases
Chronic infectious diseases (such as chronic pneumonia, inflammatory bowel disease, etc.), autoimmune diseases (such as lupus erythematosus, connective tissue disease, etc.), anemia (such as iron deficiency anemia, hemolytic anemia), malignant tumors (such as lung cancer, esophageal cancer, ovarian cancer, etc.) and splenectomy patients, are prone to secondary thrombocythemia.
What are the clinical manifestations of thrombocytosis?
When primary thrombocytosis has bleeding manifestations, it is often accompanied by thrombosis, which is often manifested as edema, ischemia, weakening of vascular pulsation and so on.
2,Fatigue and fatigue
This is a relatively nonspecific symptom.
3,The spleen grows up
Primary thrombocytosis is often accompanied by spleen growth. In severe cases, the enlarged spleen can be touched at the lower edge of the left rib.
How should thrombocytosis be treated?
After effective treatment, most patients with primary thrombocytosis can be relieved or cured. The overall prognosis is good and can maintain normal quality of life. At present, the main treatment is drug treatment.
Low dose aspirin can resist spontaneous platelet aggregation and may be effective in the treatment of primary thrombocytopenia.
2,Bone marrow suppressive drugs
It can be used to treat elderly patients with platelets greater than 1000×10 ^ 9 / L and the risk of repeated thrombosis and bleeding. Common drugs include hydroxyurea and busulfan, which can be used to inhibit the abnormal proliferation of bone marrow.
Interferon can be used to inhibit cell proliferation in primary thrombocytosis.
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