2024-08-17
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I've been bruising easily since middle school.If you feel a painful bump, your skin will turn blue the next day.Even if I go diving, there will be marks on my legs, as if I had been abused.
Skin the day after diving | Photo provided by the author
When I just graduated, I took a physical examination and found that my platelet count was only 80×109/L, while the normal value is (100~300)×109/L 。Later I went to the hospital for a follow-up check-up. Other indicators were normal, but the platelet count was still low.
The doctor looked at the test results and suspected that I had thrombocytopenia.
“This disease cannot be cured!”
I checked online and found that there are many factors that may cause thrombocytopenia, which may be related to certain diseases, such as lupus erythematosus, Helicobacter pyloriInfect、Hepatitis BHepatitis C, AIDS, etc. may also be related to certain drugs. So I went to a higher-level tertiary hospital and had a systematic check-up, but except for thrombocytopenia, all other indicators were normal.
All results point toUnexplainedimmunityThrombocytopenia。
The doctor told me that I don’t need to take medicine to control my platelet count unless it’s extremely low. I was relieved and thought it was good. But the doctor immediately refuted my carelessness:Ah? That's okay? This disease can't be cured.！”
A low platelet count can lead to a number of bleeding problems.50×109/L, the wound may not stop bleeding.9/LThere may even be spontaneous visceral bleeding and cerebral hemorrhage.If the incident happens suddenly and the amount of bleeding is heavy, then the probability of my death is quite high.。
And I can't take fever-reducing and pain-killing drugs at will, because they may cause a further decrease in platelets. Looking at my bedside drawer full of medicines, I think it's a miracle that I can live to this day.
After I got this disease, I needed to have blood drawn regularly (every two weeks) to monitor my platelets., in case it falls too lowMy platelet count is usually between (50~80)×109/L fluctuates between 100×109/L, barely reaching the boundary of normal value.
In addition to regular blood draws, the doctor also emphasized one more point.Let me pay attentionDon'tcoldBut I thought it was not something I could control, and a cold usually only lasts a week at most, so I didn’t take it too seriously.
As a result, I learned a great lesson afterwards: when the doctor tells me not to catch a cold, HE MEANS IT, he absolutely means it!
I unlocked the critical value with an asterisk
Just after New Year's Day 2021, I caught a slight cold and happened to have a routine blood test. The results of this time unlockedComplete blood testNew symbols on reports:It turns out that in addition to the up and down arrows that are not in the normal range, there is also an asterisk representing the critical value.。
My platelet count is only 7×109/L.
I was detained immediately, and the doctor told me not to move, and asked someone to come and help me with the platelet transfusion procedures. I was so scared that I cried and called my colleagues, and I still don't dare to tell my mother.
Before platelet transfusion, blood type and blood infectious diseases need to be checked, and there is a wait of about 2 hours. I also ordered a duck blood vermicelli soup to try to restore blood.The platelets in the bag look like a bag of three-yellow chicken fat, which is very nutritious just by looking at it.。
The "yellow chicken fat" in the bag | Photo provided by the author
I went home after the transfusion and came back to measure the platelet count the next day, but it was 27×109/L didn't actually increase much, but at least it was higher than before. After that, the cold gradually got better and the platelets also rose on their own.
Later, I thought about the principle and thought it had something to do with the immune system.While attacking the virus, it also killed my platelets indiscriminately., the task was "exceeded".
After this, I finally made up my mind to have a bone marrow puncture at the doctor's suggestion.
It was done in the outpatient clinic. I lay on my side on the bed with my legs curled up against the wall. After the injection of anesthesia, I felt the doctor drilling, drilling, drilling on the bone with great force, and my whole body was shaking. I didn't feel any pain at the time, just a soreness from time to time, but after returning home, it still hurt a little when I bent over and walked.
The results came out, ruling out malignant blood diseaseThe doctor gave me a bone marrow smear in case I needed it when I went to another hospital. However, I was so carefree that I took advantage of the newly purchased microscope in the office and explored it with my friends before I took the film to another hospital.
Bone marrow smear under an office microscope | Photo provided by the author
However, facing this unstained film, I still couldn't figure out which cells were which.
It is fickle and also a money-burning
In 2021, I was stranded abroad due to the pandemic, so I went to a clinic to test my platelets regularly. For unknown reasons, my platelets were low once again. The day after I had my blood drawn, the clinic called to say that the blood had clotted, and asked me to go back the next day for another test. Later, when I saw the report, I realized that my platelets were very low during the first test. Maybe the hospital was afraid of errors, so they found another reason to ask me to have another test.
First time 37×109/L, the second time 17×109/L。The next night, the doctor called me on his personal cell phone and said my platelet count was very low and recommended that I go to the emergency room immediately.。
The first time I had an IV port inserted, my blood vessels were in pain.
So during the epidemic, I ran to the emergency room in the middle of the night, had my blood pressure and temperature measured, then had an infusion port inserted (a closed infusion device implanted in the body), and had my blood drawn. After sitting in the emergency room for about 4 hours, the doctor said my platelet count was now 56×109/L, no further treatment was needed, and I was allowed to go home directly, and then an appointment was made for a follow-up examination with an immunologist in two days.
This whole thing cost me several thousand dollars, and I can only console myself and be thankful that I didn't resort to more expensive measures.
Later, in line with the principle of hard work and simplicity (poor), I thought that if it was low, I would not bleed if I did not move around, so I did not test the platelet count again. But after returning to China in 2022, the platelet count inexplicably dropped to 25×109/L, and was called back by the responsible laboratory, and all the blood drawing tubes were put in again.
I had already taken the next day off and was ready to go to the hospital for a platelet transfusion, but my platelet count went back up to 50×109/L is so much, it's just like the rain in June, it changes suddenly! So I went back to work.
I am carefully making peace with my platelets.Lie down properly to avoid bumps and collisions, seek medical attention promptly if there are signs of bleeding, and monitor your body regularly to keep track of your physical condition.
Doctor's comments
Chen Qinfen | Associate Chief Physician, Department of Hematology, Huashan Hospital, Fudan University, Associate Professor
Blood vessels are widely distributed from the subcutaneous tissue to the internal organs. When external force ruptures a blood vessel, blood will flow out of the blood vessel. When the skin is intact, bruises will appear, and when the skin is damaged, bleeding will occur. Bleeding is a normal phenomenon. However, when bleeding does not stop or spontaneous bleeding occurs, that is, when bleeding begins even though there is no bump, no collision, and no injury, we should consider the possibility of a bleeding disease.
There are many causes of bleeding disorders, including vascular problems, platelet problems, coagulation problems, etc.Even for platelet problems, there are abnormal platelet count and abnormal platelet function, and thrombocytopenia is just one of them. As a person without a medical background, the author can explain such a "rare" thrombocytopenia in a relatively authentic way, so I have to praise him first.
As the author said, the normal platelet count is (100~300)×109/L, the normal reference value range of some hospitals is (125~350)×109/L。When less than 100×109When the platelet count is less than 30×109/L, spontaneous bleeding is likely to occur.In addition to the internal bleeding and cerebral hemorrhage written by the author, spontaneous bleeding can also manifest in other parts of the body, such as sudden skin bruises, bleeding gums, and even women's delayed menstruation.
There are many causes of thrombocytopenia and treatments vary greatly, so we need to figure out the cause.Viral infections (such as colds) can indeed cause a transient decrease in platelets. Helicobacter pylori infection, antipyretic analgesics, lupus erythematosus, etc. are also possible causes of thrombocytopenia. But systematically speaking, the more common causes of thrombocytopenia include autoimmune system diseases, hypersplenism, leukemia,Multiple Myeloma, myelodysplastic syndrome, infection, pregnancy, medications (Chemotherapymedicine, the aforementioned antipyretic and analgesic drugs, etc.).Primary immune thrombocytopenia refers to autoimmune mediated thrombocytopenia with no clear cause.。
Therefore, during the diagnosis and treatment process, the doctor will patiently ask the patient whether he has a fever, whether he has taken any medicine, and whether he has other underlying diseases, and then prescribe some tests and examinations. Blood routine, coagulation function, fibrinolysis function and other tests can help us make differential diagnosis.
Sometimes a bone marrow puncture is necessary to confirm the diagnosis.。The author mentioned in the article that he had "unexplained immune thrombocytopenia", so he underwent a bone marrow puncture on the doctor's advice, which ruled out malignant blood disease.However, excluding hematologic malignancies does not mean that there are no other abnormalities in the bone marrow biopsy results.In clinical practice, we often encounter patients from other hospitals who say, "I've had a bone marrow biopsy and everything is normal." However, when you really look at the bone marrow biopsy report, you will find that there are still problems. As the main method for diagnosing blood system diseases, bone marrow puncture can understand the hematopoiesis of the bone marrow and has a good clinical significance for the diagnosis of many diseases.。
Once primary immune thrombocytopenia is diagnosed, if there is no active bleeding, there is no urgent need for treatment. Usually, the patient is treated when the platelet count is less than 30 × 109/L, we started drug treatmentPlatelet transfusion is one of the emergency treatment measures, the purpose is to quickly increase the platelet count to a safe level. Faced with the yellow platelet preparation, some people say it is like orange juice, some say it is like urine. The author said it is like chicken fat, which shows his foodie nature.
But the effect of platelet transfusion can only last for a few days, drug treatment is the long-term solution。In short, when spontaneous bleeding or bleeding does not stop, you need to see a doctor promptly and cooperate with the doctor to complete the medical history, physical examination, and a series of laboratory tests to make a clear diagnosis and start treatment in a timely manner.
Sharing of personal experiences does not constitute medical advice and cannot replace the doctor's individualized judgment on specific patients. If you need medical treatment, please go to a regular hospital.
Author: Lying down Samar
Editor: Su Man, Li Xiaoqiu
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