Thrombocytopenia

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Reduced platelet numbers or defects in function result in a bleeding tendency.
Patients develop petechial haemorrhages and bruising in skin, bleeding into mucosal surfaces and,
sometimes, severe bleeding into tissues after trauma.
The main causes are abnormal platelet production due to marrow disease, or increased destruction of platelets.
Defective production is seen in megaloblastic anaemias, marrow infiltration,
and after marrow suppression by chemotherapy.
Idiopathic thrombocytopenia (ITP) is due to autoimmune destruction of platelets, which are coated with anti-platelet antibodies.
Disease may be acute or chronic, the acute form being seen mainly in children after viral infection that generally recovers spontaneously.
The chronic form is seen mainly in adult females and is associated with autoimmune disease or drugs. Platelet destruction occurs in the spleen, and splenectomy prolongs platelet survival.
Consumption of platelets and coagulation factors is seen in disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, and haemolytic uraemic syndrome. The common mechanism is formation of microvascular thrombi that consume platelets.
Platelet dysfunction is seen in several systemic disturbances, e.g. uraemia, chronic liver disease, myeloma, and with administration of anti-platelet drugs.
Congenital disorders of platelet function are uncommon.
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