What is Thrombocytopenia？Thrombocytopenia is a myeloproliferative disease characterized by bleeding tendency and thrombosis, continuous and significant increase of peripheral blood platelets, abnormal function and excessive proliferation of bone marrow megakaryocytes. Because the disease often has repeated bleeding, it is also called hemorrhagic thrombocytopenia. The incidence is not high, mostly over 40 years old.
The onset is slow and the clinical manifestations are different. About 20% of patients, especially young people, are asymptomatic at the onset and are occasionally diagnosed due to blood test or splenomegaly. Light people only have dizziness and fatigue; Severe cases may have bleeding and thrombosis. Bleeding is often spontaneous and can occur repeatedly. About 2 / 3 of them fall ill. Gastrointestinal bleeding is common.
There can also be epistaxis, gingival bleeding, hematuria and skin mucosal ecchymosis, but purpura is rare. The incidence of thrombosis was less than that of bleeding. According to domestic statistics, 30% have arterial or venous thrombosis. After limb vascular embolism, it can show limb numbness, pain, even gangrene, and erythematous limb pain. Splenic and mesenteric vascular embolism can cause abdominal pain and vomiting. Pulmonary, cerebral and renal embolism caused corresponding clinical symptoms. Splenomegaly accounts for 80%, generally mild to moderate. A few patients have hepatomegaly.
Primary thrombocytosis should be differentiated from other myeloproliferative diseases with increased platelet count. The key points of diagnosis should include: normal red blood cell volume (increased in polycythemia vera), no Ph chromosome (which can exist in chronic myeloid leukemia), no large increase of teardrop red blood cells and bone marrow fibrosis (visible in idiopathic bone marrow fibrosis). Although the platelet count can be as low as 500000/ μ l. But usually > 1×106/ μ l。
Platelet aggregation, giant platelets and megakaryocyte fragments were found in peripheral blood smears. Megakaryocytes in bone marrow proliferate and release a large number of platelets. Bone marrow iron is usually present.
Treatment of Western Medicine
Although most experts believe that when the patient’s platelet count exceeds 1×106/ μ L and bleeding or embolism complications should be treated. However, the indications for the treatment of primary thrombocytopenia are not clear. The purpose of treatment requires thrombocytopenia to be normal or close to normal in order to prevent thrombosis and bleeding.
① Bone marrow suppressive drugs
Baixiaoan is a commonly used and effective drug. It is advisable to use a small dose, starting at 4-6mg / d. If rapid platelet decline is required, hydroxyurea can be selected as 2-4G / D and reduced to 1g / d after 3-4 days. Cyclophosphamide, phenylbutyric acid, nitrogen mustard, melphalan, etc. are effective. When the number of platelets decreases or the symptoms are relieved, the drug can be stopped. If there is recurrence, it can be used again.
② Radionuclide phosphorus (32P) was administered orally or intravenously
The first dose is 0.08-0.11mbq, and it will be administered again after three months if necessary. Generally, it is not recommended to use it because it is possible to induce leukemia.
③ Platelet separation
Rapidly reduce the number of platelets and improve symptoms. It is commonly used in gastrointestinal bleeding, pregnancy and delivery, and before selective surgery.
Recently, someone proposed to use α Interferon in the treatment of primary thrombocytopenia. It can inhibit the formation of megakaryocytes and shorten the survival time of platelets. The dose is 3-5mu / d.