Thrombocytopenic purpura, or ITP, is an immune syndrome and a common bleeding disorder. The age of onset of this disorder is usually 20-50 years, and 3-4 times more often in women than in men. Patients may have persistent bleeding or recurrent episodes, and some present with a localized bleeding tendency, such as recurrent epistaxis or excessive menstruation.
Primary thrombocytopenic purpura is characterized by the presence of anti-platelet antibodies in the blood circulation, which causes excessive platelet destruction and purpura; while the bone marrow has normal or increased megakaryocytes and infantilization.
I. Etiology of thrombocytopenic purpura
The etiology is unclear, the acute type mostly occurs after the acute viral upper respiratory tract infection is healed, suggesting that thrombocytopenia is related between the immune response to the primary infection. About half of the patients with chronic type can be measured with anti-platelet antibodies in the serum.
The symptoms of thrombocytopenic purpura
1, acute type Most of the children under 10 years old have a history of viral infection before the disease, mostly upper respiratory tract infection, rubella, measles, chickenpox; also after vaccination. The incubation period between infection and purpura is mostly within 1-3 weeks. The skin bleeding is mainly skin and mucous membrane bleeding, often more serious, the skin bleeding is in the form of petechiae of different sizes, unevenly distributed, with more extremities. Mucosal bleeding includes epistaxis, gum bleeding, and oral tongue mucosal blood blisters. Gastrointestinal and urinary tract hemorrhage, subconjunctival hemorrhage, and a few retinal hemorrhages are often present. Spinal cord or intracranial hemorrhage is common and can cause lower limb paralysis or intracranial hypertension manifestations, which can be life-threatening.
2.Chronic type
Mostly 20-50 years old, 3-4 times as many women as men. The onset of the disease is insidious. Patients may have persistent bleeding or recurrent episodes, and some show localized bleeding tendencies, such as recurrent epistaxis or excessive menstruation. Petechiae and petechiae can occur on any part of the skin and mucous membranes, but are more frequent on the distal extremities. Gastrointestinal and urinary tract bleeding may be present. Deep hematomas may also occur after trauma.
Diagnostic tests for thrombocytopenic purpura
1.Blood picture
Acute type platelets are significantly reduced, mostly below 20×10^9/L. When bleeding is severe, it can be accompanied by anemia, and white blood cells can be increased. Occasionally, there is eosinophilia. In chronic cases, platelets are mostly in the range of 30-80×10^9/L, and giant aberrant platelets are common.
2.Bone marrow picture
In acute type, the number of megakaryocytes is normal or increased, mostly of naive type, with smooth cell edges, no protrusions, little cytoplasm and large granules. In chronic type, megakaryocytes are usually increased significantly, and granular megakaryocytes are increased, but the cytoplasm has fewer granules and is more basophilic.
3.Immunological examination
4.Other
Prolonged bleeding time, positive bundle arm test, poor clot contraction, reduced platelet adhesion and aggregation, and shortened lifespan as measured by 51Cr or 111In labeled platelets.
Four, thrombocytopenic purpura treatment methods
1, general treatment: acute type and severe cases should be hospitalized.
2.Adrenocorticosteroid: Adrenocorticosteroid should be preferred for acute and chronic type with more severe bleeding.
3, Splenectomy: Splenectomy is one of the effective therapies.
4.Immunosuppressant.
5.Immunoglobulin.
6.Danazol.
7.Platelet transfusion.
8.Plasma exchange.
9.Platinopoietic drugs.
10.Chinese herbal medicine.