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Hematology which can also can be called as Haematology; it is the branch of internal medicine, physiology, Hematopathology, clinical laboratory work and pediatrics which focus of the study of blood and diseases. It includes the etiology, diagnosis, treatment, prognosis, and prevention of blood disease as well. Hematopathologist is the people who work with blood disease; they usually will collect the patient's blood and carried out the test in laboratory to investigate the patient's blood healthiness and provide the information to doctors to give treatment to patients. Blood disease is actually meant that the disorder of the blood or something wrong with the blood. The examples of blood disease can be many for example sickle cell anemia, deep vein thrombosis, and many others. One of the blood diseases which are about low count of platelet called thrombocytopenia. Thrombocytopenia is the blood disorder which has lower amount of platelet in the blood than normal. Platelet is one of the important components in the blood which play an important role in clotting and bleeding. It is made in the bone marrow and it was found it is originated from megakaryocytes which are large cells found in bone marrow. Thrombocytopenia can be caused by a variety of reasons; in general it can be classified in three ways. The first was decreased platelet production, next is increase platelet destruction or consumption and the last is increased splenic sequestration. Moreover, decreased platelet production is usually related to bone marrow problem for example in viral infection affect the bone marrow like parvovirus, mumps, and hepatitis C. In addition, some of the research shows that hepatitis C is one of the major infections which cause thrombocytopenia. For example in the mechanism of thrombocytopenia in liver cirrhosis, they believed it can be result in two ways which is the imbalance between platelet production and platelet survival. While the factors of imbalance between platelet production are direct bone marrow suppression of liver disease and abnormal thrombopoietin production or activity. For factor of platelet survival, autoantibodies directed against platelet antigens to produce an augmented removal of platelets from the splenic system. This disease name which based on this mechanism is called immune thrombocytopenia (ITP).
Every disease there is always risk factors of the disease, while for thrombocytopenia the risk factors include a few of them. First of all, it will increase the risk of unstoppable bleeding. It usually happened when the amount of the patient's platelets was under 80-100 million platelets per ml. At the same time, there is not a close relationship between the number of platelets in the blood and bleeding. However, it will actually increase the risk of hemorrhage whenever there are some drugs or hormones will influence the normal function of platelets for example aspirin will actually decrease the 'stickiness' of platelets which cause unsuccessful or delayed clotting. For this risk it can actually be reduced by less taking of aspirin or anti-inflammatory medications such as ibuprofen. Secondly, there is also a high risk of spontaneous bleeding once the platelet count drops to 10 million or lower. This bleeding usually can be observed through the skin because the skin will have tiny pin-prick hemorrhage presented which is the purpura or bruises then following minor trauma. Bleeding from the nose and mouth are common, but most serious hemorrhage can be happened in the retina and sometimes it will affect the sight of the eyes. To prevent the mouth bleed, gentle toothbrushes are recommended while for accidently mild injured need to be taken care wisely when using scissors, tools and avoid contact sports such as football, basketball and many others.
Migrate the topic to thrombocytopenia itself, it can be observed that there are some major common symptoms. At first, it can be incidentally detected when it is severe as example there is an increase in bleeding when a person is cut, injured or when having a menstrual period. While for having menstrual period women, they will have menstrual period which is long-lasting and heavy in amount than other normal women do. In addition, spontaneous bleeding can also happen with severe thrombocytopenia which the platelets are less than 10,000 to 20,000. These kinds of thrombocytopenia usually occur under the skin or mucus membrane which lining under the oral cavity, gastrointestinal tract or the nasal cavity. Moreover, there are some of the effect of this disease where petechial is one of them. Petechial is a small red, flat spots under the skin on the particular parts of the body because of pressure increases due to the gravity. For instance, the lower leg is the parts of the body when the tiny blood arteries were bleeding under the skin or mucus membrane and petechial usually are not manifest and painful. Another effect of thrombocytopenia is called purpura. It is small, purple spots under the skin as a result of hemorrhage. These are typically greater than 3 millimeters in diameter or may present union of petechial.
Recently, there are some tests can be carried out to diagnose the patients with thrombocytopenia. One of the methods is called complete blood count test (CBC). It is a test that requested by doctors or other medical professionals that gives information about the blood cells in the patient's blood. The test was involved the number of red blood cell count (RBC counts), white blood cells count (WBC count), platelet count and mean platelet volume. For immune thrombocytopenia, it will need extra tests other than a blood test like test with antibodies or assays may be done and sometimes a biopsy of bone marrow will be performed if the bone marrow problem is suspected. While the treatment for this disease is largely dependent upon the causes and the severity of the condition because some of the situations require emergent treatments and some of them just need for monitoring the platelet level. While for immune thrombocytopenia, steroids require to weaken the immune system in order to impair the attack of platelets. In some of the severe cases, intravenous immunoglobulin will be given to slow down the immune process. In general, platelet transfusion is not necessary; it will be given to the patient when the level of platelets is less than 50,000 with an activating bleeding or hemorrhage or having surgery. In the other hand, sometimes platelet transfusion may require even though there is no any bleeding and hemorrhage if the platelet level is less than 10,000.
Figure 1. Classification of patients considering the platelet number and causes of thrombocytopenia.
While for the prevalence of thrombocytopenia, there are usually hepatitis c patients as mentioned above hepatitis c is one of the major causes of thrombocytopenia. According to the University of Medicine and Pharmacy, Romania, the research involved 81 patients with hepatitis c, comprised 29 men (35.81%) and 52 women (64.19%) and it's divided into three pathological processes which is the central mechanism, most common mechanism in cirrhosis and finally peripheral mechanism. Based on the result, most of the patients the platelet level was counted between 84,000/µL and 149,000/µL, with a mean value of 122,444.4/µL. In almost patients (93.34%) presenting severe thrombocytopenia the peripheral and central mechanism co-existed. While for moderate thrombocytopenia, 26.93% of patients had only bone marrow inhibition, 11.53% of patients have autoimmune destruction, while a majority (61.54%) shows the presence of both mechanisms. In the mild thrombocytopenia group, the prevailing mechanism was peripheral. In conclusion, thrombocytopenia can actually be prevented if the causes are known and it is preventable. If a certain medication was found out to lower down the platelet level, its future use will need to be avoided.