Bruises are a normal part of life and can become more common as we age. Although most bruises aren’t much to worry about, some bruising could be a sign of a more serious problem known as血小板减少症.
If you’ve been experiencing some unexplained bruising or mild to serious bleeding, read on to learn more about this condition.
What is thrombocytopenia?
Thrombocytopenia is any disorder in which there is an abnormally low count of platelets in your blood. Broken down, “thrombo” is a Greek word that refers to blood clotting, “cyto” means cell, and “penia” means deficiency.
“患有血小板减少症的人没有足够的血小板，这是有助于血块的血液的一部分，”杰弗里·J·普, MD, PhD, medical director of the adult Hematopoietic Cellular Therapy and Transplantation (HCTT) program at横幅 - 图森大学医学中心和副主任University of Arizona Cancer CenterHCTT program. “As a result, they may bleed too much if they get an injury or cut, internally or externally.”
A normal platelet count in adults ranges from 150,000 to 450,000 platelets per microliter of blood. When a platelet count drops below 150,000, you have thrombocytopenia.
Who gets thrombocytopenia?
It’s unknown how many people have thrombocytopenia, but the following may increase your risk for developing it:
- Alcohol use disorderand alcoholism
- Autoimmune diseases, such as狼疮, which can causeidiopathic thrombocytopenia purpura, or ITP
- Bone marrow diseases, including再生障碍性贫血, leukemia, certain lymphomas and myelodysplastic syndromes
- 某些药物
- Cancer treatments likechemotherapyand radiation therapy
A low platelet count can also occur during the last trimester of pregnancy, although the cause may not be known.
血小板减少症的迹象是什么？
If you have a mild case of thrombocytopenia, you may not experience any symptoms. However, some of the signs of a low platelet count to watch out for include:
- easy or excessive bruising, called purpura
- a rash with small red or purple dots, called petechiae, which is usually seen on the lower part of the legs
- bleeding from your gums or nose
- 割伤后长时间出血
In more severe cases, symptoms may include blood in your stool, urine or vomit.
如何诊断血小板减少症？
重要的是，如果您遇到上述任何症状或有疑问，请与医疗保健提供者联系。您的提供者将进行体格检查，详细介绍您的病史，并可能会进行一些检查以检查血小板计数。
如果您的血小板计数低于正常水平，您的提供者将开始寻找其原因，并可能将您推荐给专门诊断和治疗血液疾病和病情的血液学家。
血小板减少症如何治疗？
Having a low platelet count may come with a lot of worry about your potential risk for bleeding, but it doesn’t always come with problems or will require treatment.
If you have mild thrombocytopenia and it isn’t causing symptoms, your health care provider may monitor your platelet counts and ask that you report back on any symptoms of bleeding or bruising.
PU博士说：“治疗血小板减少症取决于导致造成的严重程度和病情。”“如果血小板足够低并且需要某种形式的治疗，那么从口服和静脉注射药物到手术选择，也有多种选择。”
If your thrombocytopenia is more severe, treatment options may include:
避免药物。如果您由于对药物的反应而患有血小板减少症，则停止该药物可能是唯一需要的治疗方法。您可能还必须避免或谨慎使用其他影响血小板功能的药物。
“一些可能需要停止或避免的最常见药物包括肝素，阿司匹林，布洛芬，萘普生，像华法林这样的血液稀释剂, Eliquis or Xarelto and Plavix,” Dr. Pu said. “However, don’t discontinue any medications without the guidance or instruction of your prescribing health care provider.”
Prescribing medications.如果由于自身免疫性障碍或血小板细胞的异常破坏而发生低血小板计数，则您的医疗保健提供者可能会开处方类固醇，例如泼尼松，以减少免疫系统的反应并防止其攻击血小板。PU博士说：“这些通常是通过静脉注射或通过药丸给出的，随着计数的改善而被逐渐减少。”
Your health care provider may also prescribe immune globulin intravenous infusion (IVIG) (injection) to slow down your immune system’s destruction of platelets. “IVIG may be given in combination with steroids or as a second-line therapy if steroids alone aren’t working well enough,” Dr. Pu said. Certain medications, such as Promacta (eltrombopag) and Nplate (romiplostim), can be prescribed to help increase platelet production in the bone marrow as well.
Blood and platelet infusions.An infusion of donated platelets or blood is used to treat people who have active bleeding, are at high risk for bleeding or require surgery. Transfusing one unit of platelets can increase your platelet counts by 30,000 to 60,000 per deciliter of blood.
抗体疗法。可以注入称为Rituxan的抗体以帮助改善血小板计数。丽图尔（Rituxan）通过帮助免疫系统停止异常破坏血小板来工作。该输液可以每周进行几周，以改善血小板计数。
手术选择。如果非手术治疗无法成功增加血小板计数，则可能需要进行脾切除术以去除脾脏。
PU博士说：“脾脏是在受到免疫系统攻击时将血小板从身体中移出的位置，因此去除脾脏可能会显着改善血小板计数。”“但是，手术存在风险，脾切除术会增加您未来感染的风险。”
Lifestyle changes.If you’re at risk of developing a low platelet count due to an underlying condition, your health care provider may recommend certain lifestyle changes and preventative measures. These may include:
- increasing vitamin B12 or folate
- 完全限制或避免酒精
- 改变饮食
- 避免某些可能增加出血风险的活动，例如接触运动
Are there any complications I should be concerned about?
许多患有血小板减少症的人患有轻度至中度症状。但是，低血小板计数会增加您出血或严重出血的风险，这两者都可能危及生命。与您的医疗保健提供者交谈以制定预防和治疗计划。
You can also take steps to avoid health problems related to thrombocytopenia, watch the medications you take, avoid injuries and contact your health care provider if you notice any changes in symptoms.
如果您的血小板较低，正在出血或难以停止出血，请寻求紧急治疗。
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