免疫 血小板减少症
Overview
免疫性血小板减少症(ITP), 也被称为免疫性或特发性血小板减少性紫癜, 是一种免疫系统破坏血小板的血液疾病吗. 因此，ITP患者血小板计数较低. 这会导致皮肤上出现红色或紫色的斑点, 称为瘀点, 还有容易擦伤的问题, 流鼻血, 口腔起血泡或内出血.
Platelets are produced in the bone marrow, along with red blood cells and white blood cells. Once in the blood, platelets plug small holes in blood vessel walls, preventing or stopping bleeding. Generally, people have about 140,000 to 450,000 platelets per microliter of blood at any given time. In people with ITP, however, the immune system produces antibodies that bind to platelets. The antibody-coated platelets are then removed from the patient’s bloodstream by the spleen, an internal organ next to the stomach that is part of the lymphatic system. 这导致血小板计数低.
Some cases of ITP are mild and do not cause a significantly low platelet count or bleeding. As the platelet count decreases further, the risk of bleeding increases. Platelet counts less than 10,000 raise the concern for spontaneous bleeding. However, each person experiences bleeding 症状 differently for a given platelet count level.
In the United States, an estimated 30,000 new cases of ITP are diagnosed each year. 大约70%患有ITP的成年人是女性, and 70 percent of these women are under the age of 40 when diagnosed. ITP is more common in children than in adults, and boys and girls are equally affected.
我们治疗免疫性血小板减少症的方法
UCSF delivers compassionate, personalized care for immune thrombocytopenia (ITP). Treatment options include several types of medication that can restore platelets to adequate levels. 脾切除术, 或者手术切除脾脏, provides a permanent cure but leaves patients more susceptible to infections.
People with mild ITP generally need monitoring but no immediate treatment. 患者可能不得不改变生活方式, such as avoiding contact sports and certain medications that affect platelets, 包括阿司匹林和布洛芬.
奖 & 识别
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是全国顶尖的十大赌博平台排行榜之一
迹象 & 症状
The most common 症状 of ITP are petechiae (red or purple dots on the skin), 瘀伤和出血. 当ITP严重且血小板计数小于10时,000, patients will often notice petechiae and bruising with minimal contact.
Bleeding can occur anywhere but is most typical in the nose, mouth and gut. 女性经常注意到月经出血过多. 很少, 但最危险的是, ITP患者可能会出现脑出血, 这可能会危及生命.
诊断
ITP is suspected when an otherwise healthy patient has 症状 of a low platelet count, 或者在常规检查中发现血小板计数低 全血细胞计数(CBC)检查.
没有一种特定的测试来证明患者是否患有ITP. Instead, ITP is diagnosed by excluding other causes of a low platelet count. 这包括确保这个人没有:
- 艾滋病毒感染
- 丙型肝炎感染
- 维生素B12或叶酸缺乏
- A false low platelet count due to clumping of platelets in the blood collection tube
For certain individuals, additional testing can be performed to rule out:
- 幽门螺杆菌感染
- 病毒感染
- 骨髓增生异常综合征 (特别是60岁以上的患者)
偶尔, 某些药物(包括一些非处方药), 怀孕或医疗状况, 比如免疫系统紊乱或感染, 会与ITP有关吗. However, there is often no identifiable disease associated with ITP.
治疗
有以下情况的患者可考虑接受治疗:
- 血小板计数少于30000
- An upcoming operation or procedure that requires them to have a higher platelet count
- 活动性出血与已知的ITP诊断
如果需要治疗，最常见的治疗包括:
- Corticosteroids ("steroids") — Steroids prevent bleeding by decreasing the production of antibodies against platelets. If effective, the platelet count will rise within two to four weeks of starting steroids. 副作用包括易怒, 对胃的刺激, 体重增加, 失眠, 情绪变化和痤疮.
- Intravenous gamma globulin ("IVIg") — IVIg slows the rate of platelet destruction temporarily. IVIg works quickly — within 24 to 48 hours — but its effect typically only lasts several days to a couple weeks.
If initial treatments are not effective, the following treatments can be tried:
- Rituximab ("Rituxan") — An antibody specifically directed against the type of immune system cells that can produce antibodies against platelets. 这种疗法可能需要每周输注4次. The response to treatment is usually seen in four to six weeks after the first infusion, 虽然可能需要更长的时间.
- Thrombopoietin mimetics (Eltrombopag/"Promacta" and Romiplostim/"Nplate") — These medications increase the bone marrow production of platelets. The FDA recently approved them for use in patients who do not respond to steroids. 它们通常能很好地增加血小板计数.
- 脾切除术-脾切除术是切除脾脏的手术, the location where most of the antibody-bound platelets are removed from the bloodstream. This can be an effective and permanent solution for patients with ITP, but they will be at risk for developing certain infections in the future.
In addition, individuals with ITP may need to make lifestyle changes, including:
- 限制十大赌博靠谱网络平台接触性运动, 比如足球, 拳击和武术, 以及其他会增加头部受伤风险的运动, 包括滑雪, 滑雪和摩托车比赛.
- 病人 who have undergone splenectomy must have non-expired antibiotics at home in case they develop signs or 症状 of an infection, 比如发烧和绿色粘液. 病人 experiencing these 症状 must notify their doctor to receive instructions on whether or not to take antibiotics.
- 避免场外交易, herbal or prescription medications that can decrease the function of platelets. These include, but are not limited to, aspirin, ibuprofen, naproxen and Coumadin.
加州大学旧金山分校健康医学专家已经审查了这些信息. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
