Thrombocytopenia vs. polycythemia

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THROMBOCYTOPENIA

Thrombocytopenia denotes a low platelet count usually below 150,000 cells per micro liter (Nabili, 2010). Due to a low platelet count, the process of blood clotting is impaired and sufferers of this condition bleed abnormally whenever they are bruised.

Signs and symptoms

An individual suffering from thrombocytopenia bleeds abnormally upon bruising. Bleeding is usually observed in form of nose bleeding, or it may occur in the mouth especially from the gums. Petechiae are often observed and these are tiny red spots on the skin. It is also common to find blood in urine or stool whereas in women, menstrual flow may be abnormally heavy. A major finding is that bleeding becomes hard to stop especially as the number of platelets decreases (Nabili, 2010).

Etiology

Insufficient production of platelets, high rate of intravascular destruction of platelets as well as high rate of extravascular (in liver and spleen) destruction of platelets can lead to thrombocytopenia. Low production of platelets may be due to bone marrow disorders including viral infections (e.g. HIV infection), aplastic anemia, and cancer of the bone marrow, leukemia, liver cirrhosis, vitamin B12 and folate deficiency or chemotherapy of the bone marrow. High rate of platelets breakdown may be due to chemotherapy in treatment of hypersplenism, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura or immune thrombocytopenic purpura among other causes (Nabili, 2010).

Pathophysiology

The bleeding symptoms develop at a rate that is dependent of the cause of thrombocytopenia. Generally, bleeding time is increased in all cases with petechiae and purpura being observed on the skin surface. This indicates that the formation of a primary hemostatic plug takes more time. In case of deep injury, there is delayed bleeding with hemarthrosis being observed. As platelet count decreases, symptoms increase in severity and bleeding may occur in the digestive tract or the brain.

Diagnosis

Abnormal bleeding or unusual bruising is usually the initial diagnosis of thrombocytopenia. A platelet count test using complete blood count test follows to identify the number of platelets. Blood clotting tests can also be performed. It is also possible to diagnose thrombocytopenia using bone marrow biopsy and platelet associated antibodies test.

Medical treatment

The cause of the condition mainly determines the treatment. Steroids are used to suppress the immune system to prevent platelet destruction. Intravenous immunoglobulins also prevent autoimmunity targeting the platelets. For drug-induced thrombocytopenia, the drug is monitored or completely withdrawn. Plasma exchange may be done and platelet transfusion may be called for when platelets are very low (less than 10,000) (Nabili, 2010)

POLYCYTHEMIA

Polycythemia vera is an increase in number of red blood cells, granulocytes and platelets. In polycythemia, the central venous hematocrit goes beyond sixty five percent causing blood to become more viscous.

Signs and symptoms

Polycythemia is characterized by headache, malaise, insomnia, pruritis, vertigo, red appearance, dyspnea, bruising, parethesias, visual disturbances, weight loss, erythromelalgia and discomfort in the gastrointestinal tract including fullness and constipation and arthopathies. Other signs include skin plethora, facial pain, swelling of the liver, hypertension, cardiac hypertrophy and splenomegaly among other signs (Lessaris, 2009).

Etiology

Intrinsic causes of polycythemia include mutation in tyrosine kinase JAK2, JAK2v617F mutation, JAK2H538-K539delinsI, mutations in EPOR gene for familial and congenital polycythemia, and mutations in von Hippel-Lindau (VHL) gene. Extrinsic factors include cyanotic heart disease, renal cell cancer and cancer of the hepatocytes, chronic obstructive pulmonary disease, kyphoscoliosis and high-attitude erythrocytosis deficiency in high-affinity hemoglobin can also cause polycythemia. If the intrauterine environment is poor or the baby experiences a hypoxic condition during delivery, polycythemia may result (Lessaris, 2009).

Pathophysiology

As central hematocrit increases, blood viscosity rises and so does the oxygen content. It is possible to identify slowed flow of blood in some organs thus affecting oxygenation and subsequent transport function of blood.

Diagnosis

A hematocrit test is recommended especially at two hours age with values less than sixty five percent at this age being deemed as normal. Capillary and venous hematocrits are useful tests although venous hematocrit is the best confirmatory test.

Medical treatment

Fluid intake is a recommended treatment for polycythemia (especially neonatal). A conservative management approach requires hydration and is utilized when the hematocrit is 70-75 percent. Partial exchange transfusion (using crystalloids or colloids) helps in reducing the hematocrit level (AIIMS-NICU Protocols, 2007).

Summary

Thrombocytopenia

Low platelet count usually below 150,000 platelets per micro liter. There is abnormal bleeding and bruising and petechiae are observed. Bleeding time increases as platelet count decreases. Insufficient production of platelets and high rate of platelet breakdown results into thrombocytopenia. Increase in bleeding time means that the hemostasis process is impaired and the hemostatic plug takes time to form. Bleeding may involve the GIT and the brain. Other than observed abnormal bleeding and bruising, a complete blood count is done to measure the number of platelets. Drugs that suppress the immune system can be used to treat autoimmune-caused thrombocytopenia. Plasma exchange can also be done.

Polycythemia

This is an increase in erythrocytes among other blood cells. The hematocrit level increases beyond 65 percent and blood viscosity is increased tremendously. Facial pain, malaise, pruritis, weight loss, splenomegaly and erythromelalgia are among the main signs and symptoms of polycythemia. Mutations in JAK2 and EPOR gene are the main causes. Increased viscosity affects oxygenation and blood transport function. A hematocrit test is the recommended test for polycythemia. Hydration via a conservative approach or partial exchange transfusion is appropriate treatment approaches.
References

AIIMS-NICU Protocols. (2007). Polycythemia in the newborn. Accessed 7, June 2010 from Accessed from www.newbornwhocc.org

Lessaris, K. J. (2009). Polycythemia of the newborn. Retrieved 7, June 2010 from http://emedicine.medscape.com/article/976319-overview

Nabili, S. (2010). Thrombocytopenia (low platelet count). Retrieved 7, June 2010 from http://www.medicinenet.com/thrombocytopenia_low_platelet_count/article.htm

 

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