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Thrombocytopenic purpura: forms, symptoms in children and adults, treatment

Thrombocytopenic purpura is a common cause of hemorrhage and hemorrhage in adolescents and young children. In such a situation, it is important not to get lost and try to find answers to the questions why this happened and what to do next.

What it is?

Thrombocytopenic purpura is a pathology that is characterized by a tendency to develop bleeding due to a decrease in the number of platelets in the blood. This is one of the common diseases of the hemorrhagic diathesis group.

The first manifestations of the disease begin to bother the patient at an early age. The disease is equally common in both boys and girls of younger children, but after 10-12 years, this pathology affects mainly women.

Thrombocytopenic purpura

Thrombocytopenic purpura, photo 1

The exact reason for the development of this problem is not fully understood. Infections, hormonal crises, etc. are considered to be provoking factors. They distinguish immune and non-immune mechanisms of disease development.


Idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura

photo 2

Idiopathic thrombocytopenic purpura (ITP), the second name Verlgoth's disease is one of the first known hemorrhagic diseases. The word "thrombocytopenia" says that with this pathology there is a decrease in the number of platelets. These are cells of the blood coagulation system that are involved in the reactions of thrombus formation and hemostasis.

The term “idiopathic” means that the reason for starting this process is unknown. The factor that initiates the onset of ITP may be trauma, excessive exposure to ultraviolet radiation, stress, medication, vaccinations, etc., but in more than a third of patients the disease develops for no apparent reason.

- What happens with this pathology?

The human immune system begins to consider its own platelets to be a foreign substance. In response, it produces special antiplatelet immune complexes that settle on platelets.

In the spleen, the destruction and death of such platelets labeled with immune complexes and their absorption by macrophages occurs. In the blood, the platelet count drops and the body begins to intensively produce them, which gradually leads to the depletion of the stock of these cells and their qualitative deformation.

It turns out a kind of vicious circle: on the one hand, the immune system itself destroys platelets, and it tries to restore their number by enhanced synthesis, which leads to disastrous consequences.

Types of thrombocytopenic purpura in humans

According to the mechanism of development, there are two forms of pathology:

  • Autoimmune thrombocytopenic purpura. It occurs chronically with frequent relapses, the cause of development is unclear. Antibodies are produced on their own unaltered platelets. In addition, such antibodies can attack and the precursors of these cells, as well as other blood cells and stem cells.
  • Heteroimmune. In these cases, antibodies attack only those platelets that have changed their structure under the influence of viruses, bacteria, allergens or drug action. Such immune thrombocytopenic purpura has a more favorable course, since after elimination of the causative factor, everything is normalized and the antibodies cease to be produced. This form is usually found in children.

The disease can occur in acute (up to half a year) and chronic form (more than half a year). The chronic form happens with frequent and rare relapses. Although thrombocytopenic purpura in adults is most often acute, there is a recurrent chronic form of ITP.

Depending on the number of platelets and clinical symptoms, mild, moderate and severe severity of the disease is distinguished. In addition, according to clinical signs, it is divided into:

  • “Dry” - subcutaneous hemorrhages predominate;
  • "Wet" - a combination of bleeding and hemorrhage.

Thrombocytopenic purpura in children

Thrombocytopenic purpura in children

purple thrombocytopenic, photo in children

In most cases, thrombocytopenic purpura in children begins acutely. The first manifestations of the disease may not be noticed by the parents, since children, due to their age, are very mobile and tend to get injuries and abrasions.

After the doctor begins to collect anamnesis, it is possible to establish that the signs of pathology and damage to inadequate injuries occurred in a child for a long time.

Clinically, the disease manifests itself:

1. Skin hemorrhagic syndrome. His signs are:

  • Spontaneous appearance of subcutaneous hemorrhages (hemorrhages). They are usually formed at night under the action of minimal traumatic forces: light compression, clamping, bruising;
  • A variety of sizes of such hemorrhages: from point to large, merging together;
  • The discrepancy between the size and nature of damage to the traumatic force, i.e. minor bruising can cause extensive hemorrhage;
  • Some patients have hemorrhages in the mucous membranes or sclera. This is an unfavorable sign, since there is a growing risk of a severe complication of ITP - cerebral hemorrhage;
  • Polychromic - this means that their occurrence differs in the appearance of the prescription: there are fresh bright red elements and blue-green at the stage of reverse development;
  • They are formed almost everywhere, there are no favorite places of localization of hemorrhages.

2. Bleeding. Their characteristic:

  • Develop together with skin hemorrhagic manifestations;
  • Often there are nasal, gingival and uterine bleeding, less often esophageal, gastric, renal. In girls, the disease can manifest itself in long, excessive menstruation;
  • Hemorrhage in the brain and other severe bleeding can cause death.

Important! Bleeding after tooth extraction in patients with undiagnosed thrombocytopenic purpura is a serious danger. Such bleeding begins immediately after the intervention and does not stop for a long time, causing the development of acute anemia.

In addition to this tendency to increased bleeding, the general condition of the child is not disturbed. He has no fever, no chills, or other signs of intoxication. In rare cases, an increase in the size of the spleen and liver.

In addition, with frequent long-term bleeding develop symptoms of anemia, which can be eliminated by taking the appropriate drugs.

Depending on the period, there are two forms of the disease:

Острая (геморрагический криз). 1. Acute (hemorrhagic crisis). Hemorrhagic syndrome is expressed and laboratory blood parameters are changed.

Ремиссия: 2. Remission:

- clinical. According to laboratory data, there is a decrease in the number of platelets, but there are no clinical manifestations of the disease;

- Clinical and hematological. There are no symptoms of the disease, no changes in blood tests.

Diagnosis is carried out on the basis of anamnesis, laboratory parameters and the exclusion of other possible options for thrombocytopenia.

Treatment of thrombocytopenic purpura

Treatment of thrombocytopenic purpura

Treatment of thrombocytopenic purpura depends on the form and stage of the disease. In the acute phase, bed rest and measures aimed at stopping bleeding are recommended: blood transfusions, hemostatics, etc.

During remission, all measures are aimed at preventing the development of the next bleeding.

Splenectomy (removal of the spleen) has been and remains one of the controversial methods of treatment. It is believed that this body produces antibodies that cause platelet death, but this point has not yet been fully studied.

  • The operation is performed only in the period of remission.

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