Platelet count of 70. Thrombocytopenia: Understanding Low Platelet Count and Its Implications

22.01.201911.04.2021 by alexxlab

What are the causes of thrombocytopenia. How is low platelet count diagnosed. What are the treatment options for thrombocytopenia. When should you seek medical attention for low platelet count. How does thrombocytopenia affect pregnancy. What are the risks associated with severe thrombocytopenia. How can thrombocytopenia be prevented.

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What is Thrombocytopenia and Why Does It Matter?

Thrombocytopenia is a condition characterized by a low platelet count in the blood. Platelets, also known as thrombocytes, are essential components of blood that play a crucial role in clotting and preventing excessive bleeding. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. When the count falls below 150,000, it is considered thrombocytopenia.

Why is thrombocytopenia important? A low platelet count can lead to an increased risk of bleeding, especially if the count drops significantly. Severe thrombocytopenia (platelet count below 50,000) can result in spontaneous bleeding and potentially life-threatening complications.

Common Symptoms of Thrombocytopenia

Easy bruising
Prolonged bleeding from cuts
Petechiae (small, round, reddish-purple spots on the skin)
Nosebleeds
Bleeding gums
Blood in urine or stool
Heavy menstrual periods

What Causes Thrombocytopenia?

Thrombocytopenia can result from various factors affecting platelet production, destruction, or sequestration. Understanding these causes is crucial for proper diagnosis and treatment.

Decreased Platelet Production

Several conditions can impair the bone marrow’s ability to produce platelets:

Aplastic anemia
Leukemia
Myelodysplastic syndromes
Vitamin B12 or folate deficiency
Chemotherapy or radiation therapy

Increased Platelet Destruction

In some cases, the body’s immune system mistakenly attacks and destroys platelets:

Immune thrombocytopenic purpura (ITP)
Heparin-induced thrombocytopenia (HIT)
Thrombotic thrombocytopenic purpura (TTP)
Disseminated intravascular coagulation (DIC)

Platelet Sequestration

Certain conditions can cause platelets to be trapped in the spleen:

Hypersplenism
Cirrhosis of the liver

How is Thrombocytopenia Diagnosed?

Diagnosing thrombocytopenia involves a combination of clinical evaluation, laboratory tests, and sometimes additional procedures. The process typically includes:

Complete blood count (CBC) to measure platelet levels
Peripheral blood smear to examine platelet morphology
Bone marrow biopsy in some cases
Additional tests to identify underlying causes (e.g., antibody tests for ITP)

Is a single low platelet count sufficient for diagnosis? Not always. Pseudothrombocytopenia, a laboratory artifact caused by platelet clumping in blood samples containing EDTA anticoagulant, can mimic true thrombocytopenia. Therefore, repeat testing or alternative collection methods may be necessary to confirm the diagnosis.

Treatment Options for Thrombocytopenia

The treatment of thrombocytopenia depends on its underlying cause, severity, and the patient’s overall health. Here are some common approaches:

Watchful Waiting

For mild cases or those caused by viral infections, monitoring without specific treatment may be sufficient. The platelet count often recovers on its own in these situations.

Treating Underlying Conditions

Addressing the root cause can help resolve thrombocytopenia. This may include:

Discontinuing medications that cause low platelet count
Treating infections
Managing liver disease or other chronic conditions

Medications

Various medications can be used to manage thrombocytopenia:

Corticosteroids to reduce platelet destruction in ITP
Immunoglobulins to temporarily increase platelet count
Thrombopoietin receptor agonists to stimulate platelet production
Rituximab, a monoclonal antibody, for refractory cases of ITP

Platelet Transfusions

In severe cases or before surgical procedures, platelet transfusions may be necessary to quickly increase platelet count and reduce bleeding risk.

Splenectomy

Surgical removal of the spleen may be considered in some cases of ITP that don’t respond to other treatments.

Thrombocytopenia in Pregnancy: Special Considerations

Thrombocytopenia can occur in up to 10% of pregnancies, presenting unique challenges for both mother and baby. What are the implications of low platelet count during pregnancy?

Gestational Thrombocytopenia

This is the most common cause of thrombocytopenia in pregnancy, affecting about 5-8% of pregnant women. It typically occurs in the third trimester and resolves after delivery. Gestational thrombocytopenia is generally mild and doesn’t require specific treatment.

Preeclampsia and HELLP Syndrome

These pregnancy-related conditions can cause thrombocytopenia and require close monitoring and management to prevent complications for both mother and baby.

Immune Thrombocytopenic Purpura (ITP) in Pregnancy

Women with pre-existing ITP or those who develop it during pregnancy need careful management. The condition can affect the fetus, potentially leading to neonatal thrombocytopenia.

How does thrombocytopenia impact delivery options? For women with severe thrombocytopenia, there may be restrictions on certain procedures like epidural anesthesia due to the increased risk of bleeding complications.

When to Seek Medical Attention for Low Platelet Count

While mild thrombocytopenia may not require immediate medical attention, certain situations warrant prompt evaluation:

Unexplained bruising or petechiae
Prolonged bleeding from minor cuts or injuries
Blood in urine or stool
Unusually heavy menstrual periods
Persistent nosebleeds
Bleeding gums
Severe headache or changes in vision (which could indicate intracranial bleeding)

What platelet count is considered critical? A platelet count below 10,000 per microliter is generally considered a medical emergency due to the high risk of spontaneous bleeding.

Risks and Complications of Severe Thrombocytopenia

Severe thrombocytopenia can lead to serious and potentially life-threatening complications. Understanding these risks is crucial for both patients and healthcare providers.

Bleeding Complications

The primary risk associated with severe thrombocytopenia is excessive bleeding. This can manifest in various ways:

Gastrointestinal bleeding
Intracranial hemorrhage
Excessive bleeding during surgery or after injury
Bleeding into joints or muscles

Heparin-Induced Thrombocytopenia (HIT)

This paradoxical condition can occur in patients receiving heparin therapy. Despite causing a low platelet count, HIT actually increases the risk of blood clots, which can be life-threatening if they occur in critical areas like the lungs or brain.

Complications During Pregnancy

Severe thrombocytopenia in pregnancy can lead to:

Increased risk of maternal hemorrhage during delivery
Neonatal thrombocytopenia
Limitations on pain management options during labor

Immune System Dysfunction

In cases of immune thrombocytopenia, the underlying immune system dysfunction can potentially lead to other autoimmune disorders.

How can these risks be mitigated? Early diagnosis, appropriate treatment, and close monitoring are key to preventing complications associated with severe thrombocytopenia.

Preventing Thrombocytopenia: Is It Possible?

While not all cases of thrombocytopenia can be prevented, certain measures can reduce the risk or help manage the condition effectively:

Lifestyle Factors

Maintain a balanced diet rich in vitamins and minerals
Avoid excessive alcohol consumption
Exercise regularly to promote overall health
Manage stress levels

Medication Management

If you’re taking medications known to cause thrombocytopenia, regular monitoring of platelet counts may be necessary. Never stop prescribed medications without consulting your healthcare provider.

Vaccination

Certain viral infections can cause thrombocytopenia. Staying up-to-date with vaccinations, particularly for measles, mumps, and rubella, can help prevent these infections and their complications.

Regular Check-ups

Routine blood tests during annual check-ups can help detect thrombocytopenia early, even before symptoms appear.

Genetic Counseling

For individuals with a family history of inherited thrombocytopenia, genetic counseling may be beneficial in understanding risks and making informed decisions.

Can thrombocytopenia be completely prevented? While not all cases can be prevented, being aware of risk factors and maintaining good overall health can reduce the likelihood of developing thrombocytopenia or help manage it effectively if it does occur.

Living with Thrombocytopenia: Long-term Management and Quality of Life

For individuals diagnosed with chronic thrombocytopenia, long-term management is crucial for maintaining quality of life and preventing complications. Here are some key aspects to consider:

Regular Monitoring

Periodic blood tests to check platelet counts are essential for tracking the progression of the condition and adjusting treatment as needed.

Medication Adherence

For those on long-term medications to manage thrombocytopenia, strict adherence to prescribed regimens is crucial for maintaining stable platelet counts.

Lifestyle Adjustments

Individuals with thrombocytopenia may need to make certain lifestyle changes to reduce the risk of bleeding:

Avoiding contact sports or high-risk activities
Using soft-bristled toothbrushes and electric razors
Wearing protective gear during activities that could lead to injury

Diet and Nutrition

While diet alone can’t cure thrombocytopenia, certain nutrients can support overall health and potentially aid platelet production:

Vitamin B12 and folate-rich foods
Iron-rich foods (for those with concurrent iron deficiency)
Vitamin K for its role in blood clotting

Emotional and Psychological Support

Living with a chronic condition can be challenging. Support groups, counseling, or therapy may be beneficial for coping with the emotional aspects of thrombocytopenia.

Pregnancy Planning

Women with thrombocytopenia who are planning pregnancy should consult with their healthcare providers to develop a management plan and ensure close monitoring throughout pregnancy and postpartum.

Emergency Preparedness

Patients with severe thrombocytopenia should have an emergency plan in place, including:

Wearing a medical alert bracelet
Carrying information about their condition and current medications
Knowing when and how to seek immediate medical attention

How can patients with thrombocytopenia maintain a good quality of life? By working closely with their healthcare team, adhering to treatment plans, making necessary lifestyle adjustments, and seeking support when needed, many individuals with thrombocytopenia can lead full and active lives while effectively managing their condition.

In conclusion, thrombocytopenia is a complex condition with various causes and potential complications. Understanding its mechanisms, recognizing symptoms, and following appropriate management strategies are crucial for both patients and healthcare providers. With proper care and monitoring, many individuals with thrombocytopenia can maintain good health and quality of life. As research in this field continues to advance, new treatments and management approaches may offer even better outcomes for those affected by this condition.

Thrombocytopenia – American Family Physician

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Low platelet count (thrombocytopenia): Causes, treatment, and more

A low platelet count is a blood disorder that has a long list of possible causes. It is also known as thrombocytopenia.

Reduced platelet content in the blood is not always a serious problem. However, the condition affects the ability of the blood to clot, and wounds can bleed severely with this condition. This can have serious complications in some cases.

This article examines the conditions, medications, and substances that can cause a low platelet count, including idiopathic thrombocytopenic purpura (ITP), as well as how to recognize symptoms and what to expect from treatment.

The level of platelets is usually low as a result of two main factors.

Either an underlying medical condition is causing the reduced level, or an individual is taking a medication or substance that serves to reduce platelet count.

Medication and substances

Medicines, poisonous substances, heavy alcohol drinking, and even drinks with quinine in them, such as tonic water, can cause low platelet counts. Quinine is also found in tablets for leg cramps.

If a doctor finds one of these substances to be the cause of a low platelet count, stopping intake of the substance can return the platelet count to normal. If the cause is a drug being taken for a different condition, the prescribing doctor might change the medication.

Poisons that can cause thrombocytopenia include pesticides, arsenic, and benzene.

The following are antiplatelet or anti-clotting drugs that reduce the platelet count:

glycoprotein IIb/IIIa inhibitors, including abciximab, eptifibatide, and tirofiban
heparin

Over-the-counter (OTC) medications that can cause a low platelet count include:

acetaminophen
ibuprofen
naproxen

Some prescribed medications can also cause thrombocytopenia, including:

amiodarone
ampicillin and other antibiotics
cimetidine
piperacillin
seizure medications, such as carbamazepine
sulfonamides, such as trimethoprim-sulfamethoxazole
vancomycin

Symptoms of a low platelet count only occur at severely low levels. A slightly lower-than-normal count may not produce symptoms.

If the count is low enough to cause spontaneous bleeding, an individual may notice small bleeds that create small, round, dark red spots on the skin called petechiae.

Several petechiae can merge to form bruise-like rashes called purpura.

ITP can also cause the gums or nose to bleed without reason and the presence of blood in the urine or stools. In these cases of ITP, platelet counts are below 20,000 per μl.

Platelets form a crucial part of the composition of blood. They are responsible for repairing tissue damage and play a vital role in the blood-clotting system, which helps to stop bleeding and heal wounds. Blood clotting is also known as hemostasis.

Platelets are not invisible to the naked eye. The bone marrow produces them, and they travel in the blood for an average of 10 days before being destroyed.

How do platelets stop bleeding?

Platelets plug a leak in a blood vessel wall if it becomes broken or injured.

When a blood vessel wall is damaged, it exposes a substance that activates platelets. Activated platelets trigger further events that bring in more platelets, and a blood clot starts to form. This serves to plug any leak.

Activated platelets also release sticky proteins to help form the clot. A protein known as fibrin forms a mesh of threads that holds the plug together.

A platelet count measures the concentration of platelets in the blood. A technician would carry this test out in a laboratory.

A normal platelet count is around 140,000 to 450,000 platelets per microliter (μl) of blood. When the number of platelets is low, this concentration reduces.

Women normally experience a platelet count that varies slightly during the menstrual cycle and can fall near the end of pregnancy.

The risk of bleeding increases as the platelet count drops, but bleeding problems are unlikely unless the count is less than 80,000-100,000 platelets per μl.

The following platelet counts carry the risk of serious bleeding:

Between 20,000 and 50,000 per μl: There is more risk of bleeding when injured.
Less than 20,000 per μl: Bleeding happens even without injury.
Below 10,000 platelets per μl: Spontaneous bleeding can be severe and a risk to life.

A doctor will ask some questions and perform a physical examination. The questions might cover symptoms, family history, and medications. The examination will assess for skin rashes and bruising.

A laboratory platelet count will confirm the diagnosis, showing the exact concentration of platelets in the blood. The doctor is likely to perform other blood tests at the same time.

These may include:

a bone marrow test
a complete blood count (CBC)
a blood smear test, which looks at platelets under a microscope
other blood tests to assess blood clotting

Some people may need to give a sample of their bone marrow. This involves taking fluid from the marrow through a needle. This is called a bone marrow biopsy.

A diagnosis of ITP may be made after ruling out other causes of low platelet count.

Slightly low platelet counts that do not produce symptoms may not require treatment.

For platelet counts low enough to cause physical effects, a doctor will address the cause directly. There is a wide range of possible causes. Treatment could involve switching medication or attempting to resolve an underlying medical condition.

For cases of ITP, treatment may include drugs that suppress the immune system, such as a corticosteroid drug called prednisone.

In severe cases, a blood transfusion may be necessary.

If there are no increases in platelet count after a year, a surgeon may remove the spleen in a procedure called a splenectomy. People with extremely severe or emergency presentations of low platelet count can be treated with a transfusion of platelets.

People who have a diagnosis of this condition can reduce the risk of complications by:

taking care to avoid bumps and injuries that might lead to bruises and cuts
ensuring that all of their health workers know about this condition, as it can impact treatment decisions
taking care with over-the-counter (OTC) drugs, as many contain aspirin
avoiding infections where possible, in the case of people who have had their spleen removed

Any concerns or unusual symptoms should be reported to a doctor.

ITP refers to idiopathic thrombocytopenic purpura. It is also known as immune thrombocytopenia.

The name of the condition relates to bleeding-induced rashes that occur as a result of a low platelet count. Idiopathic means that the cause is not known.

In ITP, the immune system attacks platelets. This often follows an infection in children.

ITP is a rare condition. The internal clotting that occurs can use up a large number of platelets.

Low platelet count (thrombocytopenia): Causes, treatment, and more

A low platelet count is a blood disorder that has a long list of possible causes. It is also known as thrombocytopenia.

The level of platelets is usually low as a result of two main factors.

Either an underlying medical condition is causing the reduced level, or an individual is taking a medication or substance that serves to reduce platelet count.

Medication and substances

Medicines, poisonous substances, heavy alcohol drinking, and even drinks with quinine in them, such as tonic water, can cause low platelet counts. Quinine is also found in tablets for leg cramps.

Poisons that can cause thrombocytopenia include pesticides, arsenic, and benzene.

The following are antiplatelet or anti-clotting drugs that reduce the platelet count:

glycoprotein IIb/IIIa inhibitors, including abciximab, eptifibatide, and tirofiban
heparin

Over-the-counter (OTC) medications that can cause a low platelet count include:

acetaminophen
ibuprofen
naproxen

Some prescribed medications can also cause thrombocytopenia, including:

amiodarone
ampicillin and other antibiotics
cimetidine
piperacillin
seizure medications, such as carbamazepine
sulfonamides, such as trimethoprim-sulfamethoxazole
vancomycin

Symptoms of a low platelet count only occur at severely low levels. A slightly lower-than-normal count may not produce symptoms.

If the count is low enough to cause spontaneous bleeding, an individual may notice small bleeds that create small, round, dark red spots on the skin called petechiae.

Several petechiae can merge to form bruise-like rashes called purpura.

ITP can also cause the gums or nose to bleed without reason and the presence of blood in the urine or stools. In these cases of ITP, platelet counts are below 20,000 per μl.

Platelets are not invisible to the naked eye. The bone marrow produces them, and they travel in the blood for an average of 10 days before being destroyed.

How do platelets stop bleeding?

Platelets plug a leak in a blood vessel wall if it becomes broken or injured.

Activated platelets also release sticky proteins to help form the clot. A protein known as fibrin forms a mesh of threads that holds the plug together.

A platelet count measures the concentration of platelets in the blood. A technician would carry this test out in a laboratory.

A normal platelet count is around 140,000 to 450,000 platelets per microliter (μl) of blood. When the number of platelets is low, this concentration reduces.

Women normally experience a platelet count that varies slightly during the menstrual cycle and can fall near the end of pregnancy.

The risk of bleeding increases as the platelet count drops, but bleeding problems are unlikely unless the count is less than 80,000-100,000 platelets per μl.

The following platelet counts carry the risk of serious bleeding:

Between 20,000 and 50,000 per μl: There is more risk of bleeding when injured.
Less than 20,000 per μl: Bleeding happens even without injury.
Below 10,000 platelets per μl: Spontaneous bleeding can be severe and a risk to life.

A doctor will ask some questions and perform a physical examination. The questions might cover symptoms, family history, and medications. The examination will assess for skin rashes and bruising.

A laboratory platelet count will confirm the diagnosis, showing the exact concentration of platelets in the blood. The doctor is likely to perform other blood tests at the same time.

These may include:

a bone marrow test
a complete blood count (CBC)
a blood smear test, which looks at platelets under a microscope
other blood tests to assess blood clotting

Some people may need to give a sample of their bone marrow. This involves taking fluid from the marrow through a needle. This is called a bone marrow biopsy.

A diagnosis of ITP may be made after ruling out other causes of low platelet count.

Slightly low platelet counts that do not produce symptoms may not require treatment.

For cases of ITP, treatment may include drugs that suppress the immune system, such as a corticosteroid drug called prednisone.

In severe cases, a blood transfusion may be necessary.

People who have a diagnosis of this condition can reduce the risk of complications by:

taking care to avoid bumps and injuries that might lead to bruises and cuts
ensuring that all of their health workers know about this condition, as it can impact treatment decisions
taking care with over-the-counter (OTC) drugs, as many contain aspirin
avoiding infections where possible, in the case of people who have had their spleen removed

Any concerns or unusual symptoms should be reported to a doctor.

ITP refers to idiopathic thrombocytopenic purpura. It is also known as immune thrombocytopenia.

The name of the condition relates to bleeding-induced rashes that occur as a result of a low platelet count. Idiopathic means that the cause is not known.

In ITP, the immune system attacks platelets. This often follows an infection in children.

ITP is a rare condition. The internal clotting that occurs can use up a large number of platelets.

Low platelet count (thrombocytopenia): Causes, treatment, and more

A low platelet count is a blood disorder that has a long list of possible causes. It is also known as thrombocytopenia.

The level of platelets is usually low as a result of two main factors.

Either an underlying medical condition is causing the reduced level, or an individual is taking a medication or substance that serves to reduce platelet count.

Medication and substances

Medicines, poisonous substances, heavy alcohol drinking, and even drinks with quinine in them, such as tonic water, can cause low platelet counts. Quinine is also found in tablets for leg cramps.

Poisons that can cause thrombocytopenia include pesticides, arsenic, and benzene.

The following are antiplatelet or anti-clotting drugs that reduce the platelet count:

glycoprotein IIb/IIIa inhibitors, including abciximab, eptifibatide, and tirofiban
heparin

Over-the-counter (OTC) medications that can cause a low platelet count include:

acetaminophen
ibuprofen
naproxen

Some prescribed medications can also cause thrombocytopenia, including:

amiodarone
ampicillin and other antibiotics
cimetidine
piperacillin
seizure medications, such as carbamazepine
sulfonamides, such as trimethoprim-sulfamethoxazole
vancomycin

Symptoms of a low platelet count only occur at severely low levels. A slightly lower-than-normal count may not produce symptoms.

If the count is low enough to cause spontaneous bleeding, an individual may notice small bleeds that create small, round, dark red spots on the skin called petechiae.

Several petechiae can merge to form bruise-like rashes called purpura.

ITP can also cause the gums or nose to bleed without reason and the presence of blood in the urine or stools. In these cases of ITP, platelet counts are below 20,000 per μl.

Platelets are not invisible to the naked eye. The bone marrow produces them, and they travel in the blood for an average of 10 days before being destroyed.

How do platelets stop bleeding?

Platelets plug a leak in a blood vessel wall if it becomes broken or injured.

Activated platelets also release sticky proteins to help form the clot. A protein known as fibrin forms a mesh of threads that holds the plug together.

A platelet count measures the concentration of platelets in the blood. A technician would carry this test out in a laboratory.

A normal platelet count is around 140,000 to 450,000 platelets per microliter (μl) of blood. When the number of platelets is low, this concentration reduces.

Women normally experience a platelet count that varies slightly during the menstrual cycle and can fall near the end of pregnancy.

The risk of bleeding increases as the platelet count drops, but bleeding problems are unlikely unless the count is less than 80,000-100,000 platelets per μl.

The following platelet counts carry the risk of serious bleeding:

Between 20,000 and 50,000 per μl: There is more risk of bleeding when injured.
Less than 20,000 per μl: Bleeding happens even without injury.
Below 10,000 platelets per μl: Spontaneous bleeding can be severe and a risk to life.

A doctor will ask some questions and perform a physical examination. The questions might cover symptoms, family history, and medications. The examination will assess for skin rashes and bruising.

A laboratory platelet count will confirm the diagnosis, showing the exact concentration of platelets in the blood. The doctor is likely to perform other blood tests at the same time.

These may include:

a bone marrow test
a complete blood count (CBC)
a blood smear test, which looks at platelets under a microscope
other blood tests to assess blood clotting

Some people may need to give a sample of their bone marrow. This involves taking fluid from the marrow through a needle. This is called a bone marrow biopsy.

A diagnosis of ITP may be made after ruling out other causes of low platelet count.

Slightly low platelet counts that do not produce symptoms may not require treatment.

For cases of ITP, treatment may include drugs that suppress the immune system, such as a corticosteroid drug called prednisone.

In severe cases, a blood transfusion may be necessary.

People who have a diagnosis of this condition can reduce the risk of complications by:

taking care to avoid bumps and injuries that might lead to bruises and cuts
ensuring that all of their health workers know about this condition, as it can impact treatment decisions
taking care with over-the-counter (OTC) drugs, as many contain aspirin
avoiding infections where possible, in the case of people who have had their spleen removed

Any concerns or unusual symptoms should be reported to a doctor.

ITP refers to idiopathic thrombocytopenic purpura. It is also known as immune thrombocytopenia.

The name of the condition relates to bleeding-induced rashes that occur as a result of a low platelet count. Idiopathic means that the cause is not known.

In ITP, the immune system attacks platelets. This often follows an infection in children.

ITP is a rare condition. The internal clotting that occurs can use up a large number of platelets.

Low platelet count (thrombocytopenia): Causes, treatment, and more

A low platelet count is a blood disorder that has a long list of possible causes. It is also known as thrombocytopenia.

The level of platelets is usually low as a result of two main factors.

Either an underlying medical condition is causing the reduced level, or an individual is taking a medication or substance that serves to reduce platelet count.

Medication and substances

Medicines, poisonous substances, heavy alcohol drinking, and even drinks with quinine in them, such as tonic water, can cause low platelet counts. Quinine is also found in tablets for leg cramps.

Poisons that can cause thrombocytopenia include pesticides, arsenic, and benzene.

The following are antiplatelet or anti-clotting drugs that reduce the platelet count:

glycoprotein IIb/IIIa inhibitors, including abciximab, eptifibatide, and tirofiban
heparin

Over-the-counter (OTC) medications that can cause a low platelet count include:

acetaminophen
ibuprofen
naproxen

Some prescribed medications can also cause thrombocytopenia, including:

amiodarone
ampicillin and other antibiotics
cimetidine
piperacillin
seizure medications, such as carbamazepine
sulfonamides, such as trimethoprim-sulfamethoxazole
vancomycin

Symptoms of a low platelet count only occur at severely low levels. A slightly lower-than-normal count may not produce symptoms.

If the count is low enough to cause spontaneous bleeding, an individual may notice small bleeds that create small, round, dark red spots on the skin called petechiae.

Several petechiae can merge to form bruise-like rashes called purpura.

ITP can also cause the gums or nose to bleed without reason and the presence of blood in the urine or stools. In these cases of ITP, platelet counts are below 20,000 per μl.

Platelets are not invisible to the naked eye. The bone marrow produces them, and they travel in the blood for an average of 10 days before being destroyed.

How do platelets stop bleeding?

Platelets plug a leak in a blood vessel wall if it becomes broken or injured.

Activated platelets also release sticky proteins to help form the clot. A protein known as fibrin forms a mesh of threads that holds the plug together.

A platelet count measures the concentration of platelets in the blood. A technician would carry this test out in a laboratory.

A normal platelet count is around 140,000 to 450,000 platelets per microliter (μl) of blood. When the number of platelets is low, this concentration reduces.

Women normally experience a platelet count that varies slightly during the menstrual cycle and can fall near the end of pregnancy.

The risk of bleeding increases as the platelet count drops, but bleeding problems are unlikely unless the count is less than 80,000-100,000 platelets per μl.

The following platelet counts carry the risk of serious bleeding:

Between 20,000 and 50,000 per μl: There is more risk of bleeding when injured.
Less than 20,000 per μl: Bleeding happens even without injury.
Below 10,000 platelets per μl: Spontaneous bleeding can be severe and a risk to life.

A doctor will ask some questions and perform a physical examination. The questions might cover symptoms, family history, and medications. The examination will assess for skin rashes and bruising.

A laboratory platelet count will confirm the diagnosis, showing the exact concentration of platelets in the blood. The doctor is likely to perform other blood tests at the same time.

These may include:

a bone marrow test
a complete blood count (CBC)
a blood smear test, which looks at platelets under a microscope
other blood tests to assess blood clotting

Some people may need to give a sample of their bone marrow. This involves taking fluid from the marrow through a needle. This is called a bone marrow biopsy.

A diagnosis of ITP may be made after ruling out other causes of low platelet count.

Slightly low platelet counts that do not produce symptoms may not require treatment.

For cases of ITP, treatment may include drugs that suppress the immune system, such as a corticosteroid drug called prednisone.

In severe cases, a blood transfusion may be necessary.

People who have a diagnosis of this condition can reduce the risk of complications by:

taking care to avoid bumps and injuries that might lead to bruises and cuts
ensuring that all of their health workers know about this condition, as it can impact treatment decisions
taking care with over-the-counter (OTC) drugs, as many contain aspirin
avoiding infections where possible, in the case of people who have had their spleen removed

Any concerns or unusual symptoms should be reported to a doctor.

ITP refers to idiopathic thrombocytopenic purpura. It is also known as immune thrombocytopenia.

The name of the condition relates to bleeding-induced rashes that occur as a result of a low platelet count. Idiopathic means that the cause is not known.

In ITP, the immune system attacks platelets. This often follows an infection in children.

ITP is a rare condition. The internal clotting that occurs can use up a large number of platelets.

Low platelet count (thrombocytopenia): Causes, treatment, and more

A low platelet count is a blood disorder that has a long list of possible causes. It is also known as thrombocytopenia.

The level of platelets is usually low as a result of two main factors.

Either an underlying medical condition is causing the reduced level, or an individual is taking a medication or substance that serves to reduce platelet count.

Medication and substances

Medicines, poisonous substances, heavy alcohol drinking, and even drinks with quinine in them, such as tonic water, can cause low platelet counts. Quinine is also found in tablets for leg cramps.

Poisons that can cause thrombocytopenia include pesticides, arsenic, and benzene.

The following are antiplatelet or anti-clotting drugs that reduce the platelet count:

glycoprotein IIb/IIIa inhibitors, including abciximab, eptifibatide, and tirofiban
heparin

Over-the-counter (OTC) medications that can cause a low platelet count include:

acetaminophen
ibuprofen
naproxen

Some prescribed medications can also cause thrombocytopenia, including:

amiodarone
ampicillin and other antibiotics
cimetidine
piperacillin
seizure medications, such as carbamazepine
sulfonamides, such as trimethoprim-sulfamethoxazole
vancomycin

Symptoms of a low platelet count only occur at severely low levels. A slightly lower-than-normal count may not produce symptoms.

If the count is low enough to cause spontaneous bleeding, an individual may notice small bleeds that create small, round, dark red spots on the skin called petechiae.

Several petechiae can merge to form bruise-like rashes called purpura.

ITP can also cause the gums or nose to bleed without reason and the presence of blood in the urine or stools. In these cases of ITP, platelet counts are below 20,000 per μl.

Platelets are not invisible to the naked eye. The bone marrow produces them, and they travel in the blood for an average of 10 days before being destroyed.

How do platelets stop bleeding?

Platelets plug a leak in a blood vessel wall if it becomes broken or injured.

Activated platelets also release sticky proteins to help form the clot. A protein known as fibrin forms a mesh of threads that holds the plug together.

A platelet count measures the concentration of platelets in the blood. A technician would carry this test out in a laboratory.

A normal platelet count is around 140,000 to 450,000 platelets per microliter (μl) of blood. When the number of platelets is low, this concentration reduces.

Women normally experience a platelet count that varies slightly during the menstrual cycle and can fall near the end of pregnancy.

The risk of bleeding increases as the platelet count drops, but bleeding problems are unlikely unless the count is less than 80,000-100,000 platelets per μl.

The following platelet counts carry the risk of serious bleeding:

Between 20,000 and 50,000 per μl: There is more risk of bleeding when injured.
Less than 20,000 per μl: Bleeding happens even without injury.
Below 10,000 platelets per μl: Spontaneous bleeding can be severe and a risk to life.

A doctor will ask some questions and perform a physical examination. The questions might cover symptoms, family history, and medications. The examination will assess for skin rashes and bruising.

A laboratory platelet count will confirm the diagnosis, showing the exact concentration of platelets in the blood. The doctor is likely to perform other blood tests at the same time.

These may include:

a bone marrow test
a complete blood count (CBC)
a blood smear test, which looks at platelets under a microscope
other blood tests to assess blood clotting

Some people may need to give a sample of their bone marrow. This involves taking fluid from the marrow through a needle. This is called a bone marrow biopsy.

A diagnosis of ITP may be made after ruling out other causes of low platelet count.

Slightly low platelet counts that do not produce symptoms may not require treatment.

For cases of ITP, treatment may include drugs that suppress the immune system, such as a corticosteroid drug called prednisone.

In severe cases, a blood transfusion may be necessary.

People who have a diagnosis of this condition can reduce the risk of complications by:

taking care to avoid bumps and injuries that might lead to bruises and cuts
ensuring that all of their health workers know about this condition, as it can impact treatment decisions
taking care with over-the-counter (OTC) drugs, as many contain aspirin
avoiding infections where possible, in the case of people who have had their spleen removed

Any concerns or unusual symptoms should be reported to a doctor. 9/L. This is a bit of a mouthful, so doctors and nurses usually just refer to the number (for example, a platelet count of 150).

Thrombocytopenia may happen if the bone marrow is not making enough platelets, or if platelets are being used or destroyed faster than the bone marrow can replace them.

In people who have lymphoma, thrombocytopenia might happen because of:

Lymphoma in the bone marrow

If lymphoma cells are in the bone marrow, they take up space that is normally used to make healthy blood cells. This can lower the number of platelets your bone marrow makes, so you develop thrombocytopenia.

Thrombocytopenia caused by lymphoma in the bone marrow often begins to improve once treatment for the lymphoma has started to work and the number of lymphoma cells decreases.

Lymphoma treatments

Although the aim of chemotherapy is to kill lymphoma cells, some healthy cells are also affected. This can include the cells in your bone marrow that make new platelets. If these cells don’t make enough platelets to replace the ones that die off naturally, your platelet count falls.

The number of platelets in your blood generally starts to drop 7 to 10 days after chemotherapy and reaches its lowest point about 2 weeks after treatment. Platelet levels gradually return to normal after 4 to 5 weeks.

Not all chemotherapy regimens (combinations of drugs) cause thrombocytopenia.

Radiotherapy can cause thrombocytopenia if it is used to treat a large area or if it is given in combination with chemotherapy.

Some antibody therapies and targeted drugs can also cause thrombocytopenia.

Splenomegaly

As well as circulating in your blood, some platelets are stored in your spleen. Because these platelets are not in your bloodstream, they don’t help with clotting and they’re not included in your platelet count. If your spleen is bigger than normal (splenomegaly), more platelets collect there. This leaves fewer platelets than normal in your bloodstream.

Immune thrombocytopenia

Sometimes, lymphoma can cause your immune system to make antibodies against your own cells. These antibodies are known as ‘autoantibodies’.

If the autoantibodies stick to your platelets, the platelets are destroyed when they pass through the spleen. If your bone marrow can’t make new platelets fast enough to replace the ones that are destroyed, your platelet count drops and thrombocytopenia develops. This type of thrombocytopenia is known as ‘immune thrombocytopenia’. It is unusual in people with Hodgkin lymphoma and most types of non-Hodgkin lymphoma, but it can affect up to 1 in 10 people with chronic lymphocytic leukaemia (CLL).

Most people with a low platelet count don’t have any symptoms. This is because your body has a built-in reserve with many more platelets than you need for day-to-day life.

If your platelet count falls to very low levels, you might notice some symptoms and signs. A general guide to what you might experience at different platelet counts is:

slightly low platelet count (above 50): you will probably have no symptoms at all
low platelet count (30 to 50): you might bruise more easily and bleed for longer if you cut yourself
very low platelet count (10 to 30): you might bleed after very minor injuries that wouldn’t normally bleed, bleed for longer than usual, and bruise more easily
extremely low platelet count (below 10): you are at risk of bleeding even without an obvious cause.

If you have a low platelet count that causes bleeding, you might also develop anaemia.

Contact your medical team if you develop any of the following symptoms:

nosebleeds
bleeding gums after brushing your teeth
heavy periods in women
bleeding for longer than normal after a cut or scratch
bruising more easily than usual
small, red or purple spots called ‘purpura’ or ‘petechiae’ on your skin (often on your legs), your lips or in your mouth
blood in your vomit
blood in your urine
blood in your poo (this might be obvious, bright red blood or it can make your poo black and sticky)
persistent headache, blurred vision or a change in your level of consciousness.

If you start bleeding, get in touch with your hospital straight away.

Figure: Purpura (small, red or purple patches) on the legs

Figure: Petechiae (tiny red or purple spots) on the inside of the mouth

Thrombocytopenia is often short-lived and many people with a low platelet count don’t need any treatment at all. However, if your platelet count is very low, or you are at particular risk of bleeding, you might need treatment. This might include:

Treatment for immune thrombocytopenia is different, because it does not respond well to platelet transfusions.

Changes to your medicines

Some medicines, including blood-thinning medicines, some antibiotics and some treatments you can buy over-the-counter (for example, aspirin), can cause thrombocytopenia, or increase your risk of bleeding once thrombocytopenia has developed. Your medical team will check what medicines you are taking and will stop or adjust the dose of any that might be affecting your platelet count.

If you are having chemotherapy and your platelet count is very low, your chemotherapy dose might be reduced or you might have a longer break between treatment cycles. Sometimes, your chemotherapy regimen might be changed.

Platelet transfusion

Platelet transfusions are similar to blood transfusions, given for anaemia. You might need a platelet transfusion if:

you have an extremely low platelet count (less than 10)
you have a very low platelet count (less than 20) and a fever
you have a low or very low platelet count (less than 30 to 50) and you are bleeding
you have a low platelet count (generally less than 50) and you need to have an operation or other medical procedure that puts you at risk of bleeding.

Platelet transfusions aim to increase your platelet count enough to stop any bleeding or to reduce your risk of bleeding. Because the platelets get used up, the effect only lasts for a few days.

Other treatments

Sometimes, a medicine called ‘tranexamic acid’ might be used as well as, or instead of, a platelet transfusion. It prevents or reduces bleeding by stopping blood clots from being broken down.

Occasionally, you might need other treatments to help your blood clot, such as an injection of vitamin K or an infusion of fresh frozen plasma (similar to a blood transfusion).

Treatments for immune thrombocytopenia

If your thrombocytopenia is caused by autoantibodies destroying your platelets, platelet transfusions don’t usually work. Instead, you will probably be treated with steroids, such as prednisolone. The dose of steroid is high to begin with, which may cause irritation to your stomach. You might be given another drug to protect your stomach. Once your platelet levels are under control, the dose of steroid is lowered.

Steroids are effective for most people who have autoimmune thrombocytopenia. If steroids aren’t effective, other possible treatments include immunoglobulin replacement therapy, antibody treatment with rituximab or a splenectomy (having your spleen removed). Some people need treatment with drugs that suppress (dampen) your immune system (immunosuppressants).

If your platelet level still doesn’t improve, you might need treatment with a drug called a ‘thrombopoeitin receptor agonist’. Thrombopoietin is a hormone (a chemical messenger) that tells your bone marrow to make more platelets. Thrombopoeitin receptor agonists are medicines that mimic the effects of thrombopoietin. You might be treated with them if:

you have immune thrombocytopenia
your platelet count hasn’t responded to other treatments
you are very ill
you have a high risk of bleeding and
you need frequent courses of treatment for your thrombocytopenia.

Reducing your risk of bleeding

If you have low platelets, there are some simple precautions you can take to reduce your risk of bleeding.

Food, drink and medicines

Try to avoid food that might make your mouth bleed (for example, crisps).
Limit how much alcohol you drink (it can make bleeding worse).
Do not take aspirin or other blood-thinning medicines unless your doctor has told you to.
Do not use enemas or suppositories.

Activities

Take extra care to avoid cutting yourself when using knives or scissors.
Avoid high-impact sports (for example, long-distance running) and contact sports (for example, rugby).
Wear gloves, long sleeves and long trousers to help protect you from scratches and cuts when gardening or doing DIY.
Take care to avoid burns when ironing and cooking.
Wear shoes outside.

Hygiene

Use lip balm and moisturiser to stop your lips and skin drying out.
Brush your teeth gently using a soft toothbrush and avoid flossing to prevent your gums bleeding.
Do not have any dental work done if possible.
Avoid blowing your nose too hard or too often.
Use an electric razor instead of wet shaving.
Use sanitary towels instead of tampons.
Try not to strain when using the toilet.
Use a water-based lubricant during sex. (You may be advised to avoid sex completely if your platelet count is lower than 50.)

What to do if you start to bleed

Stay calm.
Sit down or lie down.
Apply pressure to the injury if you can.
Use an ice pack to slow the bleeding.
If possible, raise the injury above the level of your heart.
Contact your hospital.

Platelet count (Plt)

Plt – small plate cells that quickly respond to inflammation, activation of clotting, or bleeding that occurs. Platelets form the primary blood clot in the area of the damaged vessel.

In manual mode, for counting platelets, it is supposed to take a separate drop of blood for making and staining a smear and then counting platelets.

p> In automatic mode, when analyzing in an “RBC-cuvette”, particles of 2–20 fl are classified as platelets.The resulting raw data are validated using mathematical criteria and extrapolated to a lognormal distribution from 0 to 70 fl.

In some analyzers, for more accurate platelet counting, the sample is treated with special antibodies that are active against surface platelet receptors.

Reference interval
150–350 * 10 ⁹ / l

Reduced values - thrombocytopenia – a condition in which the number of platelets does not exceed 150 * 10 ⁹ / L (150 thousand / μL).Clinical signs of bleeding develop with a decrease in the number of platelets to 50 * 10 ⁹ / L (50 thousand / μL). A decrease in the number of platelets may be due to:

increased platelet destruction;

90,033 increased platelet consumption;

insufficient formation of platelets.

Increased values - thrombocytosis – an increase in the number of platelets in the peripheral blood more than 400 * 10 ⁹ / L (400 thousand / μL), can be primary and secondary.

Primary thrombocytosis is characteristic of all chronic myeloproliferative diseases (chronic myeloid leukemia, idiopathic myelofibrosis, essential thrombocythemia, erythremia).

Secondary thrombocytosis occurs:

for acute and chronic inflammatory processes (rheumatoid arthritis, periarteritis nodosa, ulcerative colitis, osteomyelitis, etc.), as well as for sepsis;
amyloidosis;

90,033 iron deficiency states against the background of chronic blood loss;

malignant neoplasms as a manifestation of a paraneoplastic reaction;
hemolytic anemia;
after acute blood loss, splenectomy;
in the treatment of certain drugs (vitamin B12, androgens, adrenaline, erythropoietin, etc. ).

Thrombocytopenia: Symptoms, Diagnosis and Treatment

Thrombocytopenia is the term for all conditions in which the number of platelets in the blood is low. A person may feel quite normal, however, such a condition with thrombocytopenia is dangerous, since internal bleeding of any organs can occur at any time, and the most dangerous thing is that a cerebral hemorrhage can occur.

Pathology occurs more often in women than in men.The detection rate in children is one in 20 thousand.

Reasons

Often the cause of the disease is an allergic reaction of the body to various medications, as a result of which there is drug thrombocytopenia . With such a malaise, the body produces antibodies directed against the drug. Medicines that affect the appearance of circulatory insufficiency of bodies include sedatives, alkaloid and antibacterial agents.

Immunity problems caused by the consequences of blood transfusions can also be the cause of deficiency. Especially often, the disease manifests itself with a mismatch of blood groups.

Most often observed in the human body autoimmune thrombocytopenia . In this case, the immune system is unable to recognize its platelets and rejects them from the body. As a result of rejection, antibodies are produced to remove foreign cells.

If the ailment has a pronounced form of an isolated disease, then it is called idiopathic thrombocytopenia or Werlhof’s disease .It is believed that such thrombocytopenia occurs against the background of a hereditary predisposition.

The manifestation of the disease in the presence of congenital immunodeficiency is also characteristic.

Lack of platelets in the body is observed in people with a reduced composition of vitamin B12 and folic acid. Excessive radioactive or radiation exposure is not excluded for the appearance of insufficient blood cells.

Symptoms

Usually, the first signal of a decrease in the level of platelets is the appearance of skin hemorrhages with minor injury (impact, compression) of soft tissues.Patients note the frequent occurrence of bruises, a specific small-point rash on the body and extremities, hemorrhages in the mucous membranes, increased bleeding of the gums, etc. at injection sites. Bleeding caused by trauma or medical manipulation (such as tooth extraction) can last from several hours to several days.

With a significant decrease in the number of platelets, spontaneous bleeding occurs (nasal, uterine, pulmonary, renal, gastrointestinal), pronounced hemorrhagic syndrome after surgery. Profuse intractable bleeding and cerebral hemorrhage can be fatal.

Diagnostics

First of all, if thrombocytopenia is suspected, a complete blood count should be done to determine the number of cellular elements and to verify (confirm) the diagnosis of thrombocytopenia.

Many diseases occurring with thrombocytopenia have rather vivid symptoms, so differential diagnosis in such cases is not difficult. This applies, first of all, to severe oncological pathologies (leukemia, metastases of malignant tumors in the bone marrow, myeloma, etc.), systemic connective tissue diseases (systemic lupus erythematosus), liver cirrhosis, etc.

However, additional studies are often necessary (bone marrow puncture, immunological tests, etc.)P.).

Treatment

Bleeding with mild thrombocytopenia does not develop. Medication is usually not required. A wait-and-see approach is recommended and the cause of the platelet decrease is determined.

With moderate severity of the disease, hemorrhages in the oral mucosa, increased bleeding of the gums, and increased frequency of nosebleeds are possible. In case of bruises and injuries, extensive hemorrhages into the skin can form, which does not correspond to the volume of damage.Drug therapy is recommended only if there are factors that increase the risk of bleeding (ulcers of the gastrointestinal system, professional activity or sports associated with frequent injuries).
For moderate thrombocytopenia without pronounced manifestations of hemorrhagic syndrome, treatment at home is prescribed. Patients are advised to limit their active lifestyle during the treatment period and take all medications prescribed by the hematologist.

Patients with severe thrombocytopenia are subject to compulsory hospitalization.Such patients, in addition to medication, can be prescribed various therapeutic and surgical measures aimed at eliminating thrombocytopenia and the causes that caused it.

Additional methods of thrombocytopenia treatment are: transfusion therapy (transfusion of donated blood, plasma or platelets to the patient), spleen removal and bone marrow transplantation.

Platelets in the blood: norm and pathology

To determine the level of platelets, it is recommended to use the service “general (clinical) blood test”.

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A coagulogram is necessary to assess the properties of blood for coagulability, as a rule, it is prescribed in conjunction with a general blood test.

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A person whose circulatory system is functioning correctly can be seen immediately: he is cheerful and active, in a good mood, has a supply of strength and energy. For the normal functioning of the circulatory system, it is necessary that all its components cope with their “duties”.So, small platelets – platelets – are responsible for one of the most important properties of blood – its clotting. What else are platelets in the blood needed for and what happens if their number changes? Those who care about their health need to know the answers to these questions.

What do platelets in the blood mean?

Platelets are formed elements of blood, small platelets are formed in the red bone marrow, the material is the plasma of its cells (megakaryocytes).There is no nucleus in platelets, but a large number of granules (up to 200) are present. These cells normally have a round or oval shape, and their size depends on age (young, adult, mature) and averages 2–5 µm. However, if a platelet comes into contact with a surface that is different from the endothelium (the inner surface of blood vessels and cardiac cavities), it is activated – it has up to 10 processes, which are 5-10 times the size of the platelet itself. Thus, cells, if necessary, “close” wounds and stop bleeding.The platelet granules contain the so-called platelet factors: adenosine diphosphorate, thrombin, thromboxane and others. They are necessary for the formation of special compounds – lysocine and B-lysine – which are capable of destroying the membranes of some bacteria, thereby protecting the body from the entry of pathogens into it.

Thanks to the pseudopods, platelets move in the blood stream. They can stick to the surface of foreign objects, grabbing and “digesting” them, sticking to each other, forming a blood clot – protection from bleeding.These plates take an active part in hemostasis (blood coagulation), and also deliver nutrients to the endothelium.

A platelet lives from 7 to 12 days, and then is destroyed in the liver, lungs or spleen.

After getting acquainted with the basic functions of platelets, it becomes clear why their lack or overload in the body can have extremely negative consequences.

This is interesting
Why, when we get nervous, quarrel, shout, do we have a headache? This is due to the fact that in stressful situations, the body begins to actively produce platelets, which can lead to the formation of blood clots in the vessels.Blood clots block the free movement of blood through the vessels, including the brain. This is what causes migraines.

Platelet count

The number of platelets is measured in thousands per microliter of blood. For men, 200-400 thousand U / μL is considered the norm, and for women – 180-320 thousand U / μL. During menstruation, the level can drop to 75-220 thousand U / μL – this is normal. The indicator also decreases during pregnancy – to approximately 100-310 thousand U / μl.

In children, the normal platelet count in the blood depends on age.For example, in newborns, it is 100-420 thousand U / μL, and in babies from 2 weeks to 12 months, there are 150-350 thousand U / μL. In children from 1 to 5 years old, the amount is considered normal – 180-380 thousand U / μL, and from 5 to 7 years – 180-450 thousand U / μL. It is necessary to donate blood for analysis once a year to determine the number of platelets in the biomaterial and to notice deviations from the norm in time. After all, changing the number of these colorless blood cells can increase the risk of blood clots or, conversely, bleeding.With existing deviations, it is recommended to conduct a study more often than 1 time per year.

Plates are counted in laboratory conditions in three ways: in a counting chamber using a phase contrast device, in Fonio stained blood smears and using hematological analyzers. In the analysis result form, the indicator is designated as PLT or Platelets.

Elevated platelets in the blood: causes

An increase in the number of platelets (thrombocytosis) may indicate tuberculosis, leukemia, lymphogranulomatosis, liver and kidney cancer.It accompanies such diseases as erythrocytosis, arthritis, chronic myeloid leukemia, enteritis, as well as acute infections, anemia, hemolysis. With general poisoning, severe stress, blood loss, the number of these cells also increases. Thrombocytosis leads to the development of thrombocythemia. The number of platelets also increases as a result of dysfunctions of bone marrow stem cells.

Pay attention!
Oddly enough, with significant blood loss, the number of platelets does not decrease, but increases.This is due to the fact that the body tries to compensate for losses as much as possible. A decrease in the indicator is noted only in the first hours after the onset of bleeding, but after a day, the level of platelets rises significantly above normal.

If there is an injury, surgery, overweight, excessive alcohol consumption, then the resulting thrombocytosis is called secondary. It is characterized by increased production of thrombopoietin, which is responsible for cell division and maturation in the bone marrow.

Regardless of the reason, going beyond the normal range of the indicator requires consultation with a doctor and the appointment of appropriate therapy. If the test result showed an increased content of platelets in the blood, the following tests are often prescribed for the diagnosis:

test for the content of C-reactive protein;
Ultrasound of the pelvic organs and abdominal cavity;
general urinalysis;
blood test for iron content;
delivery of an analysis for platelets with an interval of 3-5 days – 3 times.

Only after additional examinations, the attending physician can name the true reason for the increase in the level of platelets in the blood.

Low platelet count

A common cause of low blood cell counts (thrombocytopenia) is uncontrolled medication. Thrombocytopenia can also be observed in hepatitis, cirrhosis, bone marrow damage, hyperthyroidism, hypothyroidism, in some types of leukemia, megaloblastic anemia, alcoholism and other diseases.As a result of a decrease in the number of platelets, the vessels lose their elasticity and become fragile. Low colorless blood cell counts can be affected by nosebleeds, bleeding gums, prolonged periods, a minor cut, or a torn tooth.

To diagnose the disease that caused thrombocytopenia, the following is most often prescribed:

determination of the time of blood clotting;
test for the presence of antibodies in the blood;
magnetic resonance imaging;
Ultrasound – to study the density of internal organs, in this case the spleen and liver, as well as to detect tumors;
Genetic studies – detection of mutations in case of suspected hereditary thrombocytopenia.

A decrease in platelet count is usually treated with pharmacological agents. It can also be a transfusion of platelet mass.

How to normalize the level of colorless blood cells in the blood?

To bring the platelet count back to normal, you must first eliminate the causes of the abnormality. During the recovery period, physical, emotional and psychological stress is undesirable.

In order to raise the platelet count to to the norm of , a number of recommendations should be followed:

Eat right.You need to exclude spicy foods, pickles, alcohol, cucumbers, red grapes, cranberries, and seaweed from your diet. And instead of them add green apples, bell peppers, carrots, green grapes, celery, lingonberries. In addition, it is advised to eat liver, fresh fish, almonds, peanuts, cabbage, buckwheat, meat, herbs, bananas.
Take medications that help restore the required number of platelets. They can only be used strictly according to the doctor’s prescription!
Eliminate those drugs that lower platelet counts, including antibiotics and antidepressants.
Take vitamins A, B12 and C.

For patients with low platelet levels in the blood, a healthy lifestyle is important: you should give up bad habits, minimize the likelihood of stress, normalize sleep and rest, lead a measured lifestyle. It is forbidden to engage in active sports where there is a high probability of injury.

For a decrease in platelet count is:

take aspirin or another drug that contains acetylsalicylic acid;
give up bananas, rose hips, lentils, mangoes, nuts, pomegranates;
green tea, lemons, sea buckthorn, ginger, beets, tomatoes, garlic and onions, fish oil, grapes, cranberries, blueberries, olive and flaxseed oil should appear in the diet, that is, foods that thin the blood well;
to consume foods containing magnesium, citric, ascorbic and malic acid;
observe the drinking regime. If less than 2.5 liters are drunk per day, then the body will become dehydrated, and as a result, the vessels narrow and the blood thickens.

If your blood platelet count is abnormal, you should see a hematologist. Do not under any circumstances self-medicate. An incorrectly determined reason for an increase or decrease in the rate can lead to incorrect treatment. And this is fraught with serious consequences, such as internal hemorrhages.

Platelet count (according to Fonio)

index

22.Clinical laboratory diagnostics
22.01	General (clinical) blood test	400
22.02	General (clinical) blood test detailed (5-diff)	500
02.22.1	General (clinical) blood test expanded + microscopy (5-diff)	700
22.03	Determination of the main blood groups (A, B, 0) and Rh -accessories	400
22.04	Alloimmune antibodies (including antibodies to Rh antigen)	400
22.05	General (clinical blood test detailed (5-diff) + platelet count (according to Fonio)	600
22.06	Duration of bleeding according to Duke	100
22.07	Blood coagulability according to Sukharev	100
22.08	General (clinical) urinalysis	300
22.09	General urine analysis (without sediment microscopy)	250
22.09.1	Urine analysis according to Zimnitsky	700
09.22.2	Three-glass urine sample	600
22.10	Urine analysis according to Nechiporenko	200
22.11	Ejaculate analysis with photo registration and MAR test (Spermogram)	1 800
22. 139020	Anti-sperm IgG antibodies in semen (direct MAR test)	800
22.14	Determination of sperm DNA fragmentation	5 400
22.15	Postcoital test	500
22.16	Microscopic examination of the sediment of prostate secretion	300
22.189020	Microscopic examination for fungal diseases (skin, nails, hair)	300
22.19	Microscopic examination for demodicosis	300
22.19.1	Microscopic examination of scraping of the affected skin (detection of scabies mites / Sarcoptes scabiei)	300
22.20	Urogenital scraping for flora	350
22.22	Systemic lupus erythematosus. Determination of LE-cells (microscopy)	400
22.23	Cytological study of biomaterial	500
22.24	Cytological examination of cervical scraping and cervical canal	500
22.25	Cytological examination of breast punctate (1 education)	1,000
22.26	Cytological examination of the discharge of the mammary glands (smear-print)	500
22.27	Cytological examination of breast punctate (2 and more formations)	3,000
22.28	Histological examination (1 element)	1 400
22.29	Study on ureamikoplasma with determination of sensitivity to antibiotics	1 550
22.29.1	Study on ureaplasma (Ureaplasma urealyticum) with determination of sensitivity to antibiotics	750
22.29.2	Test for mycoplasma (Mycoplasma hominis) with determination of antibiotic susceptibility	750
22. 30	Bacteriological research on microflora	1 150
22.31	Bacteriological examination of the detached genital organs	1 150
22.32	Bacteriological examination of urine	1 150
22.33	Scraping from the nasal mucosa for eosinophils (nosogram)	200
22.34	Scraping for helminth eggs / enterobiasis	300
22.35	Study of feces for helminth eggs and protozoa	350
22.36	Coprological examination	1,000
22.37	Bacteriological examination of the secretion of the prostate / ejaculate with determination of sensitivity to antimicrobial drugs	2 560
22.38	Sowing of ear discharge for microflora, determination of sensitivity to antimicrobial drugs and bacteriophages (Eye Culture, Routine.Bacteria Identification. Antibiotic Susceptibility and Bacteriophage Efficiency testing)	1 600
22.39	Study of the level of reticulocytes in the blood	195
22.40	Study of the level of eosinophilic cationic protein in the blood	675
23. PCR diagnostics show
23.01	PCR diagnostics of chlamydia trachomatis (in scraping)	265
23.02	PCR diagnostics of chlamydia trachomatis (in synovial liquid)	380
23.03	PCR diagnostics of ureaplasma urealiticum + parvum (in scraping)	265
23.04	PCR diagnostics of mycoplasma hominis (in scraping)	265
23. 05	PCR diagnostics of mycoplasma genitalia (in scraping)	265
23.06	PCR diagnostics of gonococcus (in scraping)	265
23.07	PCR diagnostics of gonococcus (in synovial fluid)	380
23.08	PCR diagnostics of the herpes virus type 1.2 (in scraping)	265
23.09	PCR diagnostics of the herpes simplex virus type 6 in the blood	500
23.10	PCR diagnostics of the herpes simplex virus type 6 in the blood (quantitatively)	980
23.11	PCR diagnostics of cytomegalovirus (in scraping)	265
23.12	PCR diagnostics of Trichomonas (in scraping)	265
23.139020	PCR diagnostics of gardnerella (in scraping)	265
23.14	PCR diagnostics of candida (in scraping)	265
23.15	PCR diagnostics of candida (in synovial fluid)	380
23.16	PCR diagnostics of candida – typing (Candida albicans / glabrata / krusei)	610
23.16.1	Identification and typing of causative agents of fungal infections of the genus Candida, Malassezia, Saccharomyces b Debaryomyces (Mycososcreen)	1 500
23.17	PCR diagnostics of papillomavirus type 16 (in scraping)	300
23. 18	PCR diagnostics of papillomavirus type 18 (in scraping)	300
23.19	PCR diagnostics of human papillomavirus infection type 16.18 (quantitatively)	700
23.20	PCR diagnostics of papillomavirus 6, 11 types (in scraping)	350
23.21	PCR diagnostics of papillomaviruses (QUANT-21)	1 500
23.21.1	PCR diagnostics of HPV (human papillomavirus, HPV) screening of 15 types: 16,18,31,33,35,39,45,51,52,56,58,59,6,11,68)	650
23.21.2	PCR diagnostics of HPV (human papillomavirus, HPV) screening 14 + determination of integrated forms of the virus	900
23.22	PCR diagnostics of 1 infection in the blood	500
23.23	PCR diagnostics of 1 infection in the ejaculate	500
23.24	PCR diagnostics of the biocenosis of the urogenital tract (FEMOFLOR 16)	2 500
23.24.1	Study of microflora of the urogenital tract of women (FEMOFLOR Screen)	1 800
23.25	PCR diagnostics of the biocenosis of the urogenital tract (Androflor)	3,000
23.25.1	Study of microflora of the urogenital tract of men (Androflor Screen)	1 800
23.25.2	Study of microflora of the urogenital tract of men – Viraflor-A (AF screen + Quant 15)	2 500
23. 25.3	Study of microflora of the urogenital tract of women – Viraflor-F (FF screen + Quant 15)	2 500
23.26	Determination of the DNA of the hepatitis B virus (Hepatitis B virus) in blood PCR, qualitative research	700
23.27	PCR diagnostics of hepatitis B (quantitative)	3,000
23.28	Determination of RNA of the hepatitis C virus (Hepatitis C virus) in blood PCR, qualitative research	700
23.29	Determination of the genotype of the hepatitis C virus (Hepatitis C virus)	800
23.30	PCR diagnostics of hepatitis C (quantitative)	3,000
23.31	PCR diagnostics of hepatitis D (qualitative)	550
23.32	PCR diagnostics of hepatitis D + B (qualitative)	1,000
23.33	PCR diagnostics of rotavirus, norovirus, astrovirus (high quality)	1,000
23.33.1	PCR diagnostics of genogroup 1,2 noroviruses (feces)	800
23.33.2	PCR diagnostics of rotavirus, norovirus, astrovirus, enterovirus (qualitative)	1 200
23.34	PCR diagnostics of Helicobacter pylori (feces)	600
23.35	PCR diagnostics of enterovirus (feces)	439
23.36	PCR diagnostics of enterovirus (pharynx, nose)	1,000
23. 37	PCR diagnostics of acute intestinal infections (acute intestinal infections) Group F adenoviruses, Group A rotaviruses, Noroviruses of genotype 2, Astroviruses, Enterovirus, – Shigella, Enteroinvasive E.coli, Salmonella, Thermophilic Campylobacter (feces)	1 500
23.38	PCR diagnostics of herpesvirus type 4 (Epstein-Barr)	350
23.39	PCR diagnostics of herpes simplex virus type 4 (Epstein-Barr) in blood, qualitative research	500
23.40	PCR diagnostics of herpesvirus type 4 (Epstein-Barr) in blood (quantitative)	980
23.41	PCR diagnostics of mononucleosis (Epstein-Barr virus / Cytomegalovirus / Herpes simplex virus type 6) (qualitative)	740
23.42	PCR diagnostics of mononucleosis (Epstein-Barr virus / Cytomegalovirus / Herpes simplex virus type 6) (quantitative)	1 330
23.43	PCR diagnostics of toxoplasma (blood)	500
23.44	PCR diagnostics of rubella virus (blood)	500
23.46	PCR diagnostics of influenza A + B viruses (Influenza A-B)	1500
23.47	PCR diagnostics of ARVI-screen (respiratory syncytial virus, metapneumovirus, parainfluenza virus 1,2,3,4, coronaviruses, rhinoviruses, adenoviruses B, C, E, bocaviruses)	1600
23.48	PCR diagnostics of influenza A virus h2N1 (swine), h4N2 (Hong Kong)	1000
23. 49	PCR diagnostics of chlamydia pneumoniae (Chlamydophila pneumoniae)	480
23.50	PCR diagnostics of herpesvirus type 3 (chickenpox and shingles) (Varicella-Zoster Virus)	350
23.51	Genetics of thrombophilia (8 genes) with a description	3 600
23.52	Genetics of thrombophilia (2 genes) (for contraception) with Description	2 300
23.53	PCR diagnostics of Mycoplasma pneumoniae	480
23.55	Genetics of folate metabolism disorders with a description	3 100
23.57	Genetics of thrombophilia, folate metabolism with a description	5 600
23.59	Genetic predisposition to the development of breast cancer glands and ovaries (BRCA-1, BRCA-2) with a description	3 980
23.61	Genetic factor of male infertility (AZF) with Description	3 980
23.62	Genes typing of the HLAII class system (DQB1 – reproductive problems) 12 indicators	3 080
23.62.1	Genes typing of the HLA class II system. Full panel. Loci DRB1, DQA1, DQB1.	4 300
23.62.2	Genes typing of the HLA class II system. (DRB1 – organ and tissue transplantation) 13 indicators.	2 000
23.62.3	Genes typing of the HLA class II system. (DQA1 – risk of developing type I diabetes mellitus) 8 indicators.	2 000
23.64	Cardiogenetics of hypertension (full panel) with description	3 960
23.65	Description of the results of genetic studies by a geneticist	600
23.66	PCR diagnostics of Staphylococcus aureus. Qualitatively, quantitatively and identifying methicillin-sensitive Staphylococcus aureus.	600
23.67	PCR diagnostics of the causative agents of whooping cough (Bordetella pertussis), parapertussis (Bordetella parapertussis) and bronchisepticosis (Bordetella bronchiseptica)	600
23.68	PCR diagnostics of coronavirus (SAR.S-CoV-2) (qualitative definition)	2 000
23.69	PCR diagnostics of coronavirus (SARS-CoV-2) (qualitative determination) with departure for biomaterial sampling	2 250
23.70	PCR diagnostics of coronavirus (SARS-CoV-2) (qualitative definition) (result in English)	2 200
24. ELISA-diagnostics show
24.01	Rapid blood test for HIV	330
24.03	Rapid blood test for syphilis	330
24.04.1	Syphilis RPHA (passive hemagglutination reaction), qualitative	330
24.04.2	Syphilis RPHA (passive hemagglutination reaction), quantitatively (titer)	660
24.05	Rapid blood test for hepatitis B	330
24.08	Rapid blood test for hepatitis C	330
24.10	Study of the level of 25-OH vitamin D in the blood	1 600
24.10.1	Study of the level of folic acid (Folic Acid) in the blood	770
24.10.2	Study of the level of vitamin B12 (cyanocobalamin) in the blood	615
24.11	Study of the level of thyroid-stimulating hormone (TSH) in blood	450
24.12	Study of the level of free thyroxine (T4) serum blood	450
24.13	Study of the level of total triiodothyronine (T3) in blood	300
24.14	Study of the level of antibodies to thyroid peroxidase (AT-TPO) in the blood	450
24.15	Study of the level of antibodies to the thyroid-stimulating receptor hormone (TSH) in the blood	1 200
24.169020	Study of the level of antibodies to thyroglobulin (AT-TG) in blood	360
24.16.1	Thyroglobulin level study (Thyroglobulin, TG)	550
24.17	Study of the level of adrenocorticotropic (ACTH) hormone blood	570
24.17.1	Study of the level of growth hormone in the blood (growth hormone, STH)	350
24.189020	Study of the level of luteinizing hormone (LH) in serum	450
24.19	Study of the level of follicle-stimulating hormone (FSH) in blood serum	450
24.20	Study of the level of prolactin in the blood	450
24.21	Study of the level of total cortisol in the blood	450
24.22	Study of the level of progesterone in the blood	450
24.23	Study of the level of estradiol in the blood	650
24.25	Study of the level of human chorionic gonadotropin (beta-hCG) in the blood (lead time 1 day)	500
24.26	Study of the level of parathyroid hormone in the blood	500
24.27	Study of the level of ferritin in the blood	500
24.28	Study of the level of total testosterone in the blood	450
24.28.1	Study of the level of free testosterone in the blood	800
24.28.2	Study of the level of dihydrotestosterone (Dihydrotestosterone) in the blood	1 100
24.29	Study of the level of globulin binding the sex hormones (SSG), in the blood	650
24.30	Study of hormone levels DHEA-S (dehydroepiandrosterone sulfate)	450
24.31	Study of the level of 17-hydroxyprogesterone (17-OH progesterone) in the blood	500
24.32	Determination of the level of anti-Müllerian hormone in the blood	1 200
24.33	Study of the level of Inhibin B in the blood	1,000
24.34	Study of the level of C-peptide in the blood	600
24.35	Investigation of blood insulin levels	600
24.36	Determination of antibodies of class M (IgM) to rubella virus (Rubella virus) in blood	400
24.37	Determination of antibodies of class G (IgG) to rubella virus (Rubella virus) in blood	400
24.38	Determination of class M antibodies (IgM) to toxoplasma (Toxoplasma gondii) in the blood	400
24.39	Determination of antibodies of class G (IgG) to toxoplasma (Toxoplasma gondii) in the blood	400
24.40	Determination of class M antibodies (IgM) to simple virus herpes in the blood	400
24.41	Determination of antibodies of class G (IgG) to simple virus herpes in the blood	400
24.42	Determination of class M antibodies (IgM) to cytomegalovirus (Cytomegalovirus) in the blood	400
24.43	Determination of class G antibodies (IgG) to cytomegalovirus (Cytomegalovirus) in the blood	400
24.44	Determination of class G antibodies (IgG) to the pathogen opisthorchiasis (Opisthorchis felineus) in the blood	400
24.48	Determination of class G antibodies (Ig G) to antigens toxocar	410
24.49	Determination of class G antibodies (Ig G) to roundworm	760
24.50	Determination of antibodies to the causative agent of typhoid fever Salmonella typhi (RPGA)	470
24.51	Determination of total antibodies (IgA, IgM, Ig G) to the antigen CagA Helicobacter pilori	580
24.52	Determination of total antibodies (IgA, IgM, IgG) to the lamblia antigen	490
24.53	Systemic lupus erythematosus. Antibodies (IgG) to double-stranded (native) DNA	470
24.54	Study of the level of total immunoglobulin E in the blood	450
24.55	Allergopanel No. 1 – Mixed (IgE to 20 respiratory and food allergens)	4,000
24.56	Allergy panel No. 2 – Respiratory (IgE to 20 respiratory allergens)	4,000
24.57	Allergopanel No. 3 – Food (IgE to 20 food allergens)	4,000
24.58	Allergy panel No. 4 – Pediatric (IgE to 20 “Pediatric” allergens)	4,000
24.59	Rapid analysis of feces for occult blood	300
24.60	Study of the level of prostate-specific (PSA) antigen total in blood	450
24.61	Rapid blood test for total PSA (prostate-specific antigen)	330
24.62	Squamous cell carcinoma (SCC) antigen test	1 900
24.63	Study of CEA level (cancer-embryonic antigen)	510
24.64	Study of the level of tumor-associated marker CA 15-3 in the blood (carbohydrate antigen of breast cancer)	560
24.65	Study of the antigen level of adenogenic cancers CA 19-9 in blood	510
24.66	Study of the antigen level of adenogenic cancers CA 125 in blood	550
24.67	Definition of antiphospholipid syndrome (Beta-2-glycoprotein, Total phospholipid fraction, hCG, Rheumatoid factor, Double stranded DNA, Collagen), semi-quantitative	3 500
24.69	Calcitonin test	850
24.70	Determination of antibodies to cyclic citrullinated peptide (ACCP)	1,000
24.71	Study of the level of AFP (Alpha-fetoprotein)	310
24.72	Diagnosis of celiac disease (Antibodies to tissue transglutaminase IgG: IgA)	1 500
24.73	Determination of class M antibodies (IgM) to coronavirus (SARS-CoV, IgM) in blood	750
24.74	Determination of class G antibodies (IgG) to coronavirus (SARS-CoV, IgG) in blood	750
24.75	Determination of total antibodies (IgM + IgG) to coronavirus (SARS-CoV-2, IgM + IgG) in the blood	1 350
25. Biochemical studies show
25.01	Investigation of blood glucose levels	150
25.02	Glucose tolerance test with determination of glucose on an empty stomach and after exercise after 2 hours (including taking biomaterial)	600
25.03	Glucose tolerance test during pregnancy (including taking biomaterial)	750
25.04	Study of the level of glycated hemoglobin in blood	450
25.05	NOMA Assessment of insulin resistance: glucose (fasting), insulin (fasting), calculation of the HOMA-IR	700
25.06	Rehberg’s test (endogenous creatinine clearance, rate glomerular filtration) (blood, urine)	300
25.07	Study of the level of total bilirubin in the blood	150
25.08	Study of the level of bilirubin bound (conjugated) in the blood	150
25.09	Determination of the activity of aspartate aminotransferase (AST) in blood	150
25.10	Determination of the activity of alanine aminotransferase (ALT) in blood	150
25.11	Determination of the activity of gamma-glutamyltransferase (GGT) in blood	150
25.12	Study of the level of lactate dehydrogenase (LDH) in the blood	150
25.13	Study of the level of C-reactive protein (CRP)	300
25.14	Study of the level of homocysteine in the blood	1 100
25.15	Study of the level of total protein in the blood	150
25.169020	Daily loss of protein in urine	160
25.17	Study of the level of albumin in the blood	150
25.18	Study of the level of microalbumin in urine	250
25.19	Study of the level of urea in the blood	150
25.20	Study of the level of creatinine in the blood	150
25.21	Investigation of blood cholesterol levels	150
25.22	Study of low lipoprotein cholesterol density (LDL)	250
25.23	Study of high lipoprotein cholesterol density in blood (HDL)	250
25.24	Study of the level of lipoproteins in the blood (triglycerides)	200
25.25	Lipidogram (cholesterol, HDL, LDL, triglycerides, coefficient of atherogenicity)	800
25.26	Study of the level of total magnesium in the blood	180
25.27	Study of the level of inorganic phosphorus in the blood	150
25.28	Study of the level of total calcium in the blood	150
25.29	Study of the level of calcium in daily urine	160
25.30	Study of the level of iron in blood serum	200
25.30.1	Study of the level of copper (Cu) in blood serum	240
25.30.2	Study of the level of zinc (Zn) in blood serum	240
25.31	Study of iron binding capacity in blood	350
25.32	Study of the level of transferrin in the blood	400
25.33	Electrolytes (K, Na, Ca, Cl)	500
25.34	Study of the level of amylase in the blood	150
25.35	Study of the level of uric acid in the blood	150
25.36	Study of the level of uric acid in urine	150
25.37	Study of the level of ASLO in the blood (antistreptolysin O, semi-quantitative)	250
25.38	Study of the level of rheumatoid factor (semi-quantitative)	250
25.39	Study of the level of isoenzymes of creatine kinase in blood (Creatine phosphokinase CPK)	190
25.40	Study of the level of isoenzymes of creatine kinase in the blood (Creatine phosphokinase CPK-MB)	250
25.40.1	Study of the level of markers: Myoglobin / Creatine kinase MB / Troponin-I	850
25.41	Study of the level of immunoglobulin G in the blood	200
25.42	Study of the level of alkaline phosphatase in the blood	150
25.43	Study of the level of prostatic acid phosphatase in blood	160
26.Coagulological studies (assessment of the hemostasis system) show
26.01	Activated partial thromboplastin time	200
26.02	Quick prothrombin complex (prothrombin time, PTI, INR)	200
26.03	Study of the level of fibrinogen in the blood (according to Clauss)	200
26.04	Determination of thrombin time in blood	200
26.05	Determination of the concentration of D-dimer in the blood	900
26.06	Determination of the activity of antithrombin III in the blood	300

Platelets in case of COVID-19

An article published in June 2020 describes abnormal platelet activation in this disease and its relationship to the adverse course of COVID-19 in some patients.This study shows that platelet activation in COVID-19 triggers platelet activation, leading to higher levels of systemic inflammation and intense platelet aggregation, which are key to understanding the severe clinical course of COVID-19.

Coagulation disorders in COVID-19

In patients who are most severely tolerated by COVID-19, complications from the coagulation system are observed, manifested in the form of microvascular thrombi or thrombosis in the arteries and veins.Another similar condition is known – this is DIC syndrome (disseminated intravascular coagulation), in which clots form in the capillaries of all organs. Although DIC is rare in the entire population of COVID-19 patients, it occurs in over 70% of dying patients and is therefore life-critical. Biomarkers of this process are D-dimers, fibrin degradation products, increased prothrombin time, and activated partial thromboplastin time.

Blood test results for COVID-19 are often characterized by leukopenia and lymphopenia. A decrease in platelet count is a marker of higher mortality in hospitalized patients.

Platelets in severe form of COVID-19

Some scientists believe that COVID-19 may be accompanied by a decrease in platelet count through several mechanisms. For example, platelet production may decrease, while a sufficiently large number of them are destroyed or consumed in intravascular clots.

The current study focuses on platelet activation in COVID-19, as it is a major component of clotting and the release of immune and inflammatory mediators.

Many viruses interact with
platelets and their precursor cells (megakaryocytes), which leads to
increased platelet-mediated type I interferon gene expression
transport and activation of proteases.SARS-CoV-2 is known to penetrate
endothelial cells, and the resulting endothelial damage
can cause platelet migration to sites of infection. Subsequent activation
and platelet degranulation can worsen the course of the disease.

Megakaryocytes in the lungs have a different expression of immune
molecules than in the bone marrow, which may be a consequence of their infection, and, as a result,
lead to the production of platelets containing the virus in the lungs. This, in
turn, can change the nature of transcription in order to enhance production
inflammatory cytokines.

Research:
platelet hyperactivation in COVID-19

Researchers studied more than 1500
patients with suspected COVID-19, selecting 186 patients for further
analysis using PCR. They were looking for RNA-dependent RNA polymerase and genes
E. The sample included 71 patients with mild course and 34 severe
cases, 81 people – with a negative PCR result. Average age
patients with a mild form of the disease was 49 years old, and with severe – 57 years
respectively.

Thrombocytopenia was noted in all patients
(significantly lower in severe patients), but lactate dehydrogenase was higher than
usually in severe patients, which is a sign of inflammation. It was
found that in severe cases, platelets contain viral RNA and protein
E. Multiple cytokines were elevated in the blood of these patients.

It was also found that
platelets produce inflammatory molecules stronger in COVID-19 patients
when stimulated with a sufficiently low level of thrombin (a known trigger
inflammation) compared with healthy people who responded similarly
manner in response to higher doses.Thus, platelets,
seem to be focused on the production and release of certain
cytokines in patients with COVID-19.

With COVID-19, there is also
platelet degranulation, causing an inflammatory response. About it
indicates the presence of cytokines and mediators such as CD40L, PF4 and
serotonin. They, in turn, can damage the walls of blood vessels.
and attract new platelets to the site of injury. Platelets also secrete
extracellular vesicles, which are involved in both inflammatory
processes and in coagulation processes.

With COVID-19, platelet hyperactivation occurs,
as evidenced by increased phosphorylation of protein kinase C δ on
platelets. This enzyme is vital for the release of granules from
platelets, activation and aggregation of platelets, and its content is significantly
higher in severe patients than in milder cases.

Functionally also found that platelets are prone to
demonstrate an enhanced response to lower thrombin levels in order to
produce a greater number of adhered platelets, and
produce more inflammatory cytokines.

Expert opinion: Platelet hyperactivation can explain more
low platelet count and, importantly, may contribute to an explanation
thrombo-inflammatory condition associated with infection
COVID-19. Therapeutic approaches to treating COVID-19 may require
combinations of drugs that target platelet or molecule activity
platelets, in addition to drugs directed against other sources
inflammation “.

Deciphering the blood test – Scandinavia Clinic

After donating blood, we are left alone with a long list of indicators, and sometimes with frightening marks “above normal” or “below normal”.Let’s figure out what is hidden behind the abbreviations, and why the numbers can change.

A clinical blood test is prescribed to determine the number of cells, their external parameters and the ratio with the liquid part of the blood – plasma. This is usually needed to check the general condition of the body, to determine inflammation. The counting is carried out by an automatic device, but a doctor can also do this by examining a smear in a microscope.

To get the correct results, you need to properly prepare for the delivery.The main recommendation is to be tested in the morning on an empty stomach. Your doctor may give you additional instructions, such as avoiding fatty foods, drinking alcohol, or exercising a day. These guidelines should be followed.

RBC (Red blood cells) – the absolute number of red blood cells

Red blood cells are red blood cells. They contain the protein hemoglobin, which binds and carries oxygen and carbon dioxide. Thus, red blood cells perform an important transport function, therefore, there are more of them in the blood than other cells.

If there are very few red blood cells or hemoglobin, this condition is called anemia. Its appearance is associated with a deficiency of iron, vitamin B12, folic acid. Anemia often accompanies pregnancy.

An increase in the number of red blood cells is called erythrocytosis or polycythemia. The increase can be relative, for example, with dehydration, diarrhea, or smoking, when the plasma becomes less.

Or it can be absolute, when the production of red blood cells increases dramatically.The reason may be mutations in bone marrow stem cells – the progenitors of red blood cells, or an increase in the level of the hormone erythropoietin. Inhabitants of the highlands, where there is not enough oxygen, face such a condition. Tumors can also interfere with the production of erythropoietin.

HGB – the concentration of hemoglobin in the blood

Hemoglobin is a complex protein found in red blood cells. Normally, it binds to oxygen and carbon dioxide molecules. The amount of hemoglobin differs depending on age and gender.

A lack of hemoglobin indicates anemia, but additional tests are needed to establish its cause. The excess of hemoglobin, as well as of erythrocytes, can be relative, as with dehydration, or absolute, against the background of high-altitude hypoxia, high levels of erythropoietin and other factors.

Erythrocyte indices (MCV, MCH, MCHC)

The blood test describes the parameters of erythrocytes, or erythrocyte indices. They help to establish the cause of anemia, since fluctuations in these indicators indicate a violation of the process of erythrocyte production.

MCV – average erythrocyte volume

By the value of this parameter, anemia can be classified.

Microcytosis – a decrease in the parameter. The case may be iron deficiency or a violation of hemoglobin synthesis – thalassemia.

Macrocytosis – an increase in the parameter. It can be observed with a deficiency of vitamins B12, folic acid, liver disease and bone marrow disorders.

MCH – average hemoglobin content in a single erythrocyte

The decrease in MCH may be due to iron deficiency or impaired hemoglobin production.MCH can increase with a deficiency of vitamin B12, folic acid.

MCHC – the average concentration of hemoglobin in the erythrocyte mass

This is an indicator of the saturation of the erythrocyte with hemoglobin. Low MCHC values are characteristic of iron deficiency anemia, and very high values can reflect spherocytosis or agglutination — the adhesion of red blood cells.

RDW – distribution of erythrocytes by volume

The RDW parameter evaluates the volume heterogeneity of a group of erythrocytes.If this parameter is increased, then the heterogeneity is high – there are too large and too small erythrocytes.

An increase in RDW is characteristic of iron deficiency anemia, myelodysplastic

syndrome – disorders of maturation of bone marrow cells, chronic liver and kidney disease, colorectal cancer.

If there are too many non-standard cells in the sample, the analysis results may show marks: anisocytosis – the presence of cells with a changed size, anisochromia – with a changed color, poikilocytosis – with a changed shape.This is typical for different types of anemia.

B-Ret – reticulocytes

These are young precursor cells of erythrocytes, which are formed in the bone marrow and circulate in small quantities in the blood.

There are more reticulocytes in the blood when the bone marrow receives a signal to increase the production of red blood cells. This can occur with hemolytic anemia, a condition in which red blood cells are destroyed faster than expected.

A decrease in the number of reticulocytes is observed in the case of disruption of the bone marrow with aplastic anemia, as well as with a deficiency of iron, vitamin B12 and folic acid, kidney and liver diseases.

HCT – hematocrit

This indicator reflects the ratio of the volume of red blood cells and the liquid part of the blood, that is, it shows how thick the blood is.

If the indicator is increased, most likely there is a fluid deficiency in the body.This is the most common cause of high hematocrit. Other possible causes are lung disease, congenital heart disease, and polycythemia, a condition that is characterized by an increase in the number of blood cells.

If the hematocrit is low, it may indicate a deficiency of iron, vitamin B12 and folate, kidney or bone marrow disease such as leukemia, lymphoma, multiple myeloma.

PLT – platelets

Platelets are small platelets of blood.If the vessel is damaged, they are sent to the accident site and participate in the formation of a blood clot to stop bleeding.

Decreased platelet count – thrombocytopenia. It can be the result of a malfunction of the bone marrow, in which blood cells are formed. Causes: aplastic anemia, leukemia, vitamin B12 deficiency. Other reasons are platelet destruction due to autoimmune disorders or from exposure to certain drugs.

There is also a natural decrease in platelet count during menstruation or pregnancy, which in most cases is not a pathology.

Sometimes thrombocytopenia is false due to the fact that platelets stick together in a test tube under the influence of a reagent.

An increase in platelet count is called thrombocytosis or thrombocythemia. This condition may be due to chronic inflammatory processes, such as rheumatoid arthritis or tuberculosis. Thrombocytosis is also seen in acute infections, iron deficiency anemia, and after removal of the spleen. An increase in the number of platelets can be observed with disruption of the bone marrow – myeloproliferative diseases.

MPV – mean platelet volume

A decrease in the MPV index is observed with a violation of the formation of blood cells in

bone marrow, for example, with aplastic anemia, as well as under the influence of certain drugs.

An increase in MPV occurs with increased activity of the bone marrow: younger large platelets enter the bloodstream. This can lead to increased platelet destruction, myeloproliferative diseases, preeclampsia during pregnancy.

WBC (white blood cells) – the absolute content of leukocytes

Leukocytes are white blood cells. Their main function is to protect the body from any pathogens and tumor cells.

Several groups of cells are called leukocytes: neutrophils, lymphocytes, eosinophils, monocytes and basophils. Each of them has a separate function.

In a blood test, the total number of leukocytes is indicated in absolute value – the number of cells per liter.And each group is indicated either as a percentage of the total number of leukocytes, or also in absolute value.

If the total number of leukocytes fluctuates, it is important to determine through which group the change occurred.

Decrease in the number of leukocytes – leukopenia. It is observed with disruption of the bone marrow, autoimmune diseases, leukemia. A drop in white blood cell counts is characteristic of some infections, such as HIV or hepatitis. May occur against the background of chemotherapy, as well as certain medications (gastroprotective agents, antipsychotic).

An increase in leukocytes – leukocytosis. It can be both physiological and

pathological. Physiological leukocytosis, that is, natural, helps the body fight infection. There are many reasons for pathological leukocytosis. It can be a sign of inflammation, tumor, bone marrow dysfunction, or corticosteroid use.

NEUT – neutrophils

Neutrophils, or neutrophilic granulocytes, are one of the groups of leukocytes.Their main function is to protect the body from bacterial and fungal infections.

Decreased neutrophils – neutropenia. This condition is caused by the use of certain drugs, exposure to radiation, infections, vitamin B12 deficiency, aplastic anemias, immunodeficiencies, and autoimmune diseases.

An increase in the number of neutrophils – neutrophilia. It is observed in inflammatory reactions, infectious processes, tumors and autoimmune diseases, such as rheumatoid arthritis.

LYM – lymphocytes

Lymphocytes are another group of white blood cells that are the main cells of the immune system. They fight pathogens, form long-term immunity, destroy tumor cells, and are also responsible for the tolerance of the immune system to its own cells and tissues.

A decrease in the number of lymphocytes – lymphopenia. Causes of lymphopenia: viral infections – influenza, hepatitis, tuberculosis and HIV, fasting, intense physical activity, taking the hormone prednisone, chemotherapy, autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, myasthenia gravis), some types of cancer (leukemia and lymphoma).

An increase in lymphocytes – lymphocytosis is characteristic of infections: chickenpox, measles, mononucleosis, and can also be a sign of a tumor process.

EOS – eosinophils

Eosinophils are another group of leukocytes. The main function is to fight multicellular parasites. In addition, eosinophils are involved in the formation of allergic reactions.

An increase in the number of eosinophils in the blood – eosinophilia.It is necessary to pay attention to this parameter, because mainly eosinophils are in the tissues, there are very few of them in the blood – 0.5 – 2% of the total number of leukocytes.

Common causes of eosinophilia: allergic diseases such as bronchial asthma, food or drug allergies, hay fever. In the list of reasons – defeat by parasites: ascaris, echinococcus, lamblia and others. Rare cases of eosinophilia are seen in cancer – lymphoma and leukemia.

MON – monocytes

Monocytes are a group of leukocytes.Their main function is to absorb foreign cells and present them to other cells of the immune system. They also activate the production of cytokines, proteins responsible for the body’s inflammatory response. Basically, monocytes circulate in tissues, there are few of them in the blood.

Increased monocytes – monocytosis. This condition is observed with infections: chickenpox, malaria, typhoid fever, tuberculosis, syphilis. Typical for autoimmune diseases, as well as tumor diseases of the blood – leukemia.

Decrease in monocytes – monocytopenia. May result from infections: HIV, Epstein-Barr virus, adenovirus. And it is also observed with chemotherapy, lymphoma, leukemia.

BAS – basophils

Basophils are a type of white blood cell. The main function is to participate in inflammatory and allergic reactions. Changes in the number of these cells in the blood are rare.

The increased content of basophils – basophilia.It can be observed with hypothyroidism – a persistent lack of thyroid hormones, as well as with diseases of the bone marrow.

Decrease in the number of basophils – basopenia. It can appear in response to thyrotoxicosis – an excess of thyroid hormone, as well as in acute hypersensitivity reactions and infections.

Now, having noticed changes in the clinical analysis of blood, you can assume

possible reason. But do not make a diagnosis on your own, all the more so only for one indicator.Be sure to consult a doctor for accurate interpretation, prescribing additional tests and choosing treatment tactics.

Specifics of performing individual tests

Methods for performing analyzes and presenting results in different laboratories are slightly different. This section provides information on some of the features of Helix laboratory practice. There are several tests where it is important to take these differences into account.

Test “ LIH” (determination of the degree of lipemia, icterus or hemolysis of a blood sample)

Helix Laboratory Service pays special attention to pre-analytical procedures.As you know, it is at the preanalytical stage that most mistakes are made, which can lead to obtaining unreliable research results. The most common consequence of such errors is hemolysis of the blood sample. It is not uncommon for a patient to violate the rules for preparing for testing and the content of lipids or bilirubin rises in his blood. In addition, an increase in the last two indicators may be a consequence of some of the patient’s diseases. An elevated concentration of hemoglobin (hemolysis), bilirubin (icterus), or triglycerides (lipemia) in a blood sample may cause inaccurate laboratory results.

This is especially true for biochemical indicators, indicators of the hemostasis system, PCR analyzes, as well as some serological markers.

[02-014] (hereinafter: analysis number in the Helix catalog) Complete blood count

[02-025] Leukocyte formula

The General Blood Count in the Helix Laboratory Service includes eight main indicators: the total number of erythrocytes, leukocytes, platelets, hemoglobin, erythrocyte indices (MCV, MCH, MCHC) and hematocrit.

The leukocyte formula includes the total number of leukocytes, as well as the absolute (* 10 ⁹) and relative (%) number of their subpopulations: neutrophils, lymphocytes, monocytes, eosinophils and basophils.

When ordering both analyzes at the same time, the results, in addition to the above indicators, will additionally contain the following indicators:

standard deviation of erythrocytes by volume (RDW-SD)
coefficient of variation of erythrocytes by volume (RDW-CV)
platelet volume distribution (PWD)
average platelet volume (MPW)
large platelet ratio

Complete blood count and leukocyte formula are performed on automatic analyzers XN-9000 and XT-4000i (Sysmex, Japan).If normal results are obtained and there are no analyzer messages about the possible presence of microclots in the blood sample or other factors that can affect the test result, microscopic examination of the blood smear is not performed. If there are deviations from the norm presented in Table 1, the Helix Laboratory Service conducts a microscopic examination of a blood smear with automated or visual counting of leukocyte subpopulations (including stab and segmented neutrophils) and pathological forms of blood cell elements (blasts, atypical lymphocytes, etc.).) There is also an option for performing this test with mandatory microscopic examination, regardless of the result obtained during the automatic examination.

Table 1. Criteria for performing microscopy as part of a general clinical blood test.

Indicator	Children ( )							Men	Women	Actions Performed
Age	0-1	1-5		5-10		10-15		15 and older	15 and older
Hemoglobin (g / l)										Re-examination on the analyzer without performing microscopy
Neutrophils (%)	> 45		> 55		> 60		> 70	> 75		Microscopy of smear with counting leukocyte formula
Age	0-1	1-2	2-4	4-6	6-10	10-16	16 and older
Leukocytes × 10 ⁹	> 17.5	> 17.0	> 15.5	> 14.5	> 13.5	> 13.0	> 12.0
Age	0-2		2-6					> 10
Lymphocytes × 10 ⁹ / L	> 12		> 8.5					> 7
Lymphocytes (%)	> 80		> 70					> 60
Monocytes × 10 ⁹ / L	> 1.5
Basophils × 10 ⁹ / L	> 0.1
Basophils (%)	> 3
Platelets × 10 ¹² Thrombocytopenia										Checking the sample for the presence of a clot and observation microscopy of the smear
	Actions taken: – no clot was detected, thrombocytopenia is present in the survey microscopy – the commentary states: “Thrombocytopenia” ; – no clot was detected, platelet aggregation was detected in the survey microscopy – the commentary states: “Platelet aggregation.It is recommended to repeat the study to clarify the number of platelets ”; – clot detected – sample is canceled
Detected while researching: – blasts, – immature granulocytes, – atypical lymphocytes.	– in the presence of immature granulocytes, atypical lymphocytes and in the absence of changes in blood parameters, microscopic examination is not performed; – in the presence of immature granulocytes, atypical lymphocytes and in the presence of changes in blood parameters, the decision to conduct microscopy is made individually by the doctor of clinical laboratory diagnostics; – if there are other changes, a microscopic examination is performed.

[07-032] HIV 1,2 Ag / Ab Combo (determination of antibodies to HIV types 1 and 2 and antigen p24)

The test for the detection of antibodies (p24 antigen) to HIV is carried out in accordance with the requirements of Russian legislation (including the Sanitary and Epidemiological Rules SP 3.1.5.2826-10 “Prevention of HIV Infection”). A triple control of the obtained positive or dubious research results is carried out, with confirmation of such results in an expert laboratory by the method of immune blotting.

It should be noted that study 07-032 is carried out by a highly specific and highly sensitive electrochemiluminescence method on an automatic analyzer Cobas 8000 (Roche Diagnostics, Switzerland). Upon receipt of a positive or questionable result, additional statements of this study are carried out. After that, the sample is sent to the federal reference laboratory, where the result is confirmed by an expert method.

In the forms with the results, in addition to the necessary passport data of the patient, all the statements made, as well as the names, series of the test systems used in Helix and their expiration date are reflected.

[07-101] Anti-HCV, antibodies

The study is carried out by the method of enzyme immunoassay. Upon receipt of a positive or questionable result, additional confirmatory research is performed free of charge. 3 for ejaculate) 10-004 Culture of Candida spp./ yeast-like fungi with the selection of antimycotic preparations Qualitatively (there is / no growth) + determination of sensitivity to 2 antimycotic drugs (voriconazal, fluconazole) 10-005 Sowing on Chlamydia trachomatis Qualitatively (with / without growth) 10-006 Culture for Chlamydia trachomatis with determination of antibiotic susceptibility Qualitatively (with / without growth) + determination of sensitivity to antibacterial drugs 10-007 Sowing on Trichomonas vaginalis Qualitatively (with / without growth) 10-008 Intestinal dysbiosis with determination of antibiotic susceptibility Quantitative (determination of CFU / g) 10-009 Culture for hemolytic streptococcus of group A Qualitatively (with / without growth) 10-010 Sowing for diphtheria (Corynebacterium diphtheriae) Qualitatively (with / without growth) 10-012 Sowing feces for pathogenic flora (diz.group and typhoid paratyphoid group) with antibiotic sensitivity determination Qualitatively (with / without growth) + determination of sensitivity to antibacterial drugs 10-013 Intestinal dysbiosis with determination of sensitivity to antibiotics and bacteriophages Quantitative (determination of CFU / g) 10-014 Examination of the skin and nail plates for superficial mycoses Qualitatively (with / without growth) 10-015 Sowing of feces for opportunistic flora with determination of sensitivity to antibiotics Quantitative (determination of CFU / g) + determination of sensitivity to antibacterial drugs 10-022 Inoculation of the contents of the gingival pocket for aerobic microflora without antibiotic susceptibility testing Quantitative (growth rate) 10-023 Inoculation of the contents of the gingival pocket for anaerobic microflora without antibiotic susceptibility testing Quantitative (growth rate) 10-025 Sowing the contents of the gingival pocket for aerobic and facultative anaerobic flora Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs 10-026 Inoculation of the contents of the gingival pocket for anaerobic flora Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs 10-032 Mucosal candidiasis.Isolation of pure culture and determination of sensitivity to antimycotic drugs Qualitatively (there is / no growth) + determination of sensitivity to 2 antimycotic drugs (voriconazal, fluconazole) 10-035 Culture for Staphylococcus aureus (S. aureus) Qualitatively (with / without growth) 10-036 Culture for Staphylococcus aureus (S. aureus) with antibiotic susceptibility testing Qualitatively (with / without growth) 10-037 Culture for flora without determining antibiotic susceptibility Quantitative (growth rate) 10-038 Culture for aerobic and facultative anaerobic flora with determination of sensitivity to an expanded list of antibiotics and selection of the minimum effective dosage of the drug Quantitatively (degree of growth) + determination of sensitivity to an extended list of antibacterial drugs and selection of the minimum effective dosage 10-039 Intestinal dysbiosis with determination of sensitivity to bacteriophages Quantitative (determination of CFU / g) 10-040 Intestinal dysbacteriosis without determination of sensitivity to antibiotics and bacteriophages Quantitative (determination of CFU / g) 10-041 Sowing on flora with determination of susceptibility to bacteriophages Quantitative (growth rate) 10-042 Sowing of the separated wound for flora with determination of sensitivity to antibiotics Quantitative (growth rate) 10-043 Sowing for anaerobic flora Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs 10-044 Inoculation on Mycoplasma species Quantitative (growth rate) 10-045 Sowing on Ureaplasma species Quantitative (growth rate) 10-046 Sowing of wound secretions for anaerobic flora Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs 10-047 Culture of blood and cerebrospinal fluid for sterility Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs 10-048 Culture for Gardnerella vaginalis with determination of titer and sensitivity to antimicrobial drugs Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs 10-049 Sowing for aerobic and facultative anaerobic flora Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs and bacteriophages 10-050 Inoculation for Campylobacter spp. Qualitatively (with / without growth) 10-051 Sowing on Yersinia spp. Qualitatively (with / without growth) + determination of sensitivity to antibacterial drugs 10-052 Sowing on Bordetella pertussis / parapertussis Qualitatively (with / without growth) 10-053 Sowing feces for pathogenic Escherichia Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs and bacteriophages 10-054 Culture for flora with determination of sensitivity to antibiotics (stomach contents) Quantitative (growth rate) 10-055 Study of vaginal microbiocenosis with determination of sensitivity to antibiotics Quantitative (determination of CFU / g) + determination of sensitivity to antibacterial drugs 10-056 Sowing feces for opportunistic flora without determining antibiotic susceptibility Quantitative (growth rate) 10-057 Sowing feces for pathogenic flora (diz.group and typhoid paratyphoid group) without antibiotic susceptibility testing Qualitatively (with / without growth) 10-058 Sowing of detachable wounds on flora without determination of sensitivity to antibiotics Quantitative (growth rate) 10-059 Determination of blood sterility (aerobic culture) on the VITEK bioMerieux

analyzer

Quantitatively (degree of growth) + determination of sensitivity to an extended list of antibacterial drugs and selection of the minimum effective dosage 10-060 Determination of blood sterility (anaerobic culture) on the VITEK bioMerieux

analyzer

Quantitatively (degree of growth) + determination of sensitivity to an extended list of antibacterial drugs and selection of the minimum effective dosage 10-061 Culture for Staphylococcus aureus (S.aureus) without antibiotic susceptibility testing, quantitatively Quantitative (growth rate) 10-062 Culture for Staphylococcus aureus (S. aureus), quantitative result Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs and bacteriophages 10-065 Intestinal dysbiosis Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs, bacteriophages and probiotic drugs 10-067 Culture for Staphylococcus aureus (S.aureus), quality result Qualitatively (with / without growth) + determination of sensitivity to antibacterial drugs and bacteriophages 10-069 Sowing on Aspergillus spp. without determination of sensitivity to antimycotic drugs (smears of various localizations) Qualitatively (with / without growth) 10-070 Culture for Cryptococcus spp. without determination of sensitivity to antimycotic drugs (smears of various localizations) Qualitatively (with / without growth) 10-071 Sowing of fungi of the genera Candida, Aspergillus, Cryptococcus with the selection of antimycotic drugs for Candida spp.(smears of various localizations) Qualitatively (there is / no growth) + determination of sensitivity to 2 antimycotic drugs (voriconazal, fluconazole) 10-072 Sowing for pathogens of dermatomycosis (Trichophyton spp., Microsporum spp., Epidermophyton spp.) Without determining sensitivity to antimycotic drugs Qualitatively (with / without growth) 10-073 Sowing wound secretions for aerobic and facultative anaerobic flora Quantitatively (degree of growth) + determination of sensitivity to antibacterial drugs and bacteriophages 10-074 Culture of a wound discharge with determination of sensitivity to an expanded list of antibiotics and selection of the minimum effective dosage of the drug Quantitatively (degree of growth) + determination of sensitivity to an extended list of antibacterial drugs and selection of the minimum effective dosage 10-076 Culture of Candida spp.