Since junior high school, I have been easily bruised. If you feel a bump that hurts, your skin will turn blue the next day. Even if I go diving, there will be marks on my legs, like being "domestic violence".
The skin on the second day after diving 丨 Courtesy of the author
When I first graduated, I underwent an induction medical examination and found that the platelets were only 80×109/L, while the normal value was (100~300)×109/L. Later, I went to the hospital for re-examination, and the other indicators were normal, but the platelet count was still low.
The doctor looked at the test results and suspected that I was thrombocytopenia.
"This disease can't be cured!"
I checked on the Internet myself and found that there are many factors that may cause thrombocytopenia, which may be related to certain diseases, such as lupus erythematosus, Helicobacter pylori infection, hepatitis B and C AIDS, etc., and may also be related to certain drugs. So I went to the upper third-class hospital again and systematically checked it again, but except for thrombocytopenia, other indicators were still normal.
All results point to unexplained immune thrombocytopenia.
The doctor said that I have this disease, platelets are not particularly low when generally do not need to take medicine to control, I am relieved to feel very good. But the doctor immediately retorted to my heart: "Huh? Is this okay? This disease can not be cured! ”
Too low a platelet count can lead to a range of bleeding problems. Below 50×109/L, the wound may not stop bleeding. Below 30×109/L, there may even be spontaneous visceral hemorrhage, cerebral hemorrhage, if the incident is sudden, the amount of bleeding is large, then the probability of me driving the crane to the west is quite high.
And I can't take fever and painkillers casually because they may cause further platelet reductions. Looking at my well-medicated bedside drawer, I thought it was a miracle that I could survive to this day.
After I got the disease, I needed to have regular (every two weeks) blood drawn to monitor platelets in case it fell too low. Usually, my platelet situation basically fluctuates between (50 to 80) ×109/L, and when the "platelet adult" is in a good mood, he may be able to go to 100 × 109/L, barely enough to reach the boundary of the normal value.
In addition to regular blood draws, the doctor also stressed that I should pay attention not to catch a cold. But I thought it wasn't something I could control, and I usually had a cold for a week at most, so I didn't care too much.
As a result, I learned a big lesson: when the doctor said don't catch a cold, HE MEANS IT, he was absolutely serious!
I unlocked the critical value with the asterisk
Just after New Year's Day last year, I got a little cold, just in time for the routine blood draw. The result of this time allowed me to unlock the new symbol on the blood routine report: in addition to the upper and lower arrows that were not in the normal range, there was an asterisk representing the critical value.
My platelets are only 7× 109/L.
I was immediately detained, and the doctor told me not to move around, and asked someone to come and help me run the platelet transfusion clinic immediately. This situation frightened me into crying and crying for my colleagues, and I still haven't dared to tell my mother.
Before the platelet transfusion, I need to check the blood type and blood infectious diseases, and I have to wait about 2 hours in the middle, and I also ordered a duck blood vermicelli soup to eat and try to return the blood. The platelets in the bag are like a bag of three yellow chicken fat, which is greatly replenished when it looks.
The bag of "yellow chicken fat" 丨 author courtesy of the picture
After the loss, I went home and continued to measure the number of platelets the next day, but 27×109/L actually did not rise much, but it was higher than before. After that, the cold gradually improved, and the platelets rose back on their own.
Later, I thought about the principle myself and thought that it should be related to the immune system. After the cold, the immune system was mobilized, and while attacking the virus, it killed my platelets indiscriminately, which was simply "over-the-quota" to complete the task.
After this time, I finally made up my mind to go for a bone marrow aspiration under the advice of my doctor.
I was doing it in the clinic, and I lay on my side on the bed, curling my legs up against the wall. After anesthesia, I felt the doctor drilling, drilling, drilling on the bone with special efforts, and my whole body shook with it. At that time, I didn't feel any pain, it was a bout of acid, but it was still a little painful to bend over and walk around after I went back.
The results came out, ruling out malignant blood disease. The doctor gave me a bone marrow smear in case I needed it in the hospital. However, my heart was as big as mine, and before I could bring the film to the outer courtyard, I took advantage of the new purchase of a microscope in the office and explored it with my friends.
Bone marrow smear under an office microscope 丨 Author courtesy of the author
However, in the face of this unstained film, I did not understand which of these cells was which one.
Fickle it is also the money-burning it
Last year, when I was stranded abroad due to the epidemic, I found a clinic to regularly test platelets, and it was lowered for no apparent reason. On the day of the blood draw, the clinic called to say that the blood drawn was coagulated, and asked me to go to the next day to smoke again... Later, when I saw the report, I learned that the platelets were very low when the first test was taken, and maybe the hospital was afraid of errors, so it found another reason for me to smoke again.
The first 37×109/L, the second 17×109/L. The next night the doctor called from his personal cell phone and said that my platelets were very low and suggested that I go to the emergency room immediately.
The first time I was punctured in the infusion port, the blood vessels kept hurting. 丨 Courtesy of the author
So during the epidemic, I ran to the emergency room in the middle of the night, took my blood pressure and body temperature, and then was plugged into the infusion port (a closed infusion device implanted in the body) and drew blood. After sitting in the emergency room for about 4 hours, the doctor said that my platelets were now 56×109/L, and I didn't need any more treatment, let me go straight home, and then asked me to review the immunologist after two days.
This tossing and turning thousands of knives went out, and I could only comfort myself, glad that I did not use more money-burning measures.
Later, in line with the principle of hardship and simplicity (poor), I thought that I would not bleed anyway if I was low, I would not move around, so I did not test platelets again. However, after returning to China this year, platelets inexplicably fell to 25×109/L, and were caught by the responsible laboratory department with a telephone, and all kinds of blood pumping tubes were all repeated.
Originally, I had taken the next day's leave and was ready to go to the hospital for platelet transfusions, but the platelets rose back to 50×109/L more, almost like the rain in June! So I went back to work.
Now I am carefully living in peace with platelets. Obediently lie flat to prevent bumps, seek medical treatment in time if there are signs of bleeding, and adhere to regular monitoring to grasp the latest condition of the body.
Doctor reviews
Chen Qindian | Deputy Chief Physician and Associate Professor, Department of Hematology, Huashan Hospital, Fudan University
From the subcutaneous to the viscera, the blood vessels are widely distributed. When an external force ruptures a blood vessel, the blood runs outside the vessel. Bruising is seen when the skin is not broken, and bleeding is seen when the skin is broken. Bleeding is a normal phenomenon. But when the bleeding does not stop, or spontaneous bleeding occurs, that is, when it is clear that there is no bump, no bump, no injury, but it begins to bleed, we have to consider the possibility of bleeding disease.
There are many causes of bleeding disorders, including vascular problems, platelet problems, coagulation problems, etc. Even if there is a platelet problem, there are also abnormal platelet counts and abnormal platelet function, and thrombocytopenia is only one of them. As a person without a medical background, the author can talk about such a "partial door" platelet reduction more authentically, and I have to exaggerate here.
Indeed, as the authors say, normal platelet counts are (100 to 300) × 109/L, and the normal reference value range in some hospitals is (125 to 350) ×109/L. When below 100×109/L, thrombocytopenia is clinically diagnosed. Spontaneous bleeding is prone to occur when the platelet count is below 30×109/L. In addition to the visceral hemorrhage and cerebral hemorrhage written by the author, spontaneous bleeding can also manifest itself in other parts of the body, such as sudden skin ecchymosis, bleeding gums, and even the delay of the woman's aunt.
There are many causes of thrombocytopenia, and treatments vary widely, so we need to figure out why. Viral infections (such as colds) do cause a transient decrease in platelets, and Helicobacter pylori infection, antipyretic analgesics, lupus erythematosus, etc. are also possible causes of thrombocytopenia. However, systematically, the more common causes of thrombocytopenia include autoimmune system diseases, hypersplenism, leukemia, multiple myeloma, myelodysplastic syndrome, infection, pregnancy, drugs (chemotherapy drugs, antipyretic analgesics, etc.). Primary immune thrombocytopenia is autoimmune-mediated thrombocytopenia without a clear precipitating cause.
Therefore, in the process of diagnosis and treatment, the doctor will patiently ask the patient whether he has a fever, whether he has taken any drugs, whether he has other underlying diseases, and then prescribe some laboratory tests and examinations. Tests such as blood routine, coagulation function, and fibrinolytic function can all help us to make a differential diagnosis.
Sometimes a bone marrow aspiration test is necessary to confirm the diagnosis. The author mentions that he is "unexplained immune thrombocytopenia", so he performed bone puncture on the advice of the doctor, thus ruling out malignant blood disease. But the exclusion of malignant blood disease does not mean that there are no other abnormalities in the results of bone puncture. Clinically, we often encounter patients from the outside hospital saying that "bone wear has been done, it is normal", but if you really take out the bone wear report to see, there is actually a problem. As the main means of diagnosing hematologic diseases, bone marrow aspiration can understand the hematopoietic status of bone marrow, which has good clinical significance for the diagnosis of a variety of diseases.
After the diagnosis of primary immune thrombocytopenia is confirmed, if there is no active bleeding, there is no rush to treat, usually when the platelet count is below 30×109/L, we initiate drug therapy. Platelet transfusions are one of the emergency treatment measures to rapidly raise the platelet count to a safe level. In the face of the yellow platelet preparation, some say it looks like orange juice, some say it looks like urine. And the author says it's like chicken fat, and the foodie properties are evident here.
However, the effects of platelet transfusions can only last for a few days, and drug treatment is the long-term solution. In short, when spontaneous bleeding occurs or bleeding does not stop, it is necessary to seek medical treatment in time, cooperate with the doctor to complete the medical history consultation, physical examination, and a series of laboratory tests to clarify the diagnosis and start treatment at the right time.
Sharing personal experience does not constitute a diagnosis and treatment recommendation, can not replace the doctor's individual judgment of a specific patient, if you need to go to a regular hospital.
Author: Sama lying flat
Editors: Suman, Li Xiaoqiu