The Analysis Of Etiology In1400Patients With Thrombopenia

Objective：To investigate the etiology and clinical features of inpatients who werenewly diagnosed thrombopenia (TP) in general hospital.Method：The clinical data of1400inpatients with newly diagnosed thrombopenia fromOctober2009to November2010were collected. Constituent ratio of etiology, plateletindices changes were retrospectively analyzed, dependablity between platelet and partlaboratory data, born marrow were also be observed.Ⅰ. Constituent ratio of cause of1400thrombocytopenic cases1. Among1400thrombocytopenic cases, there were810cases（57.9%）caused by non-hematological systemic disorder (NHSD),414cases（29.6%）caused by hematologicalsystemic disorder (HSD),169（12.0%） cases of acatalepsy and7cases ofpseudothrombocyto-penia（0.5%）.2. The810cases caused by NHSD, including213cases (26.3%) of hypersplenism,153cases (18.9%) with infection,134cases (16.5%) of drug-induced,90cases (11.1%) of renalinadequacy,58cases (7.2%) of hepatitis,46cases (5.7%) of circulatory disease,42cases(5.2%) of tumors,28cases (3.5%) of connective tissue diseases,27cases (3.3%) of endocrinediseases,19cases (2.3%) of pregnancy.3. Among414cases caused by HSD, constituent ratio of ITP was the largest andaccounted for40.2%of166cases, followed by83acute leukemia cases (20.0%). Rarecauses, less than1percent, were including4cases of myelofibrosis,4cases of HELLPsyndrome,3cases of sideroblastic anemia,2cases of diphasicr anemia,2cases ofthrombotic thrombocytopenic purpura(TTP),2cases of Evans syndrome,2cases ofparoxysmal nocturnal hemoglobinuria,2cases of chronic myeloid leukemia, one cases ofthe reactive plasma cell histiocytosis.Ⅱ. Comparison of decrease degree of plateletAmong810thrombocytopenic cases caused by NHSD, there were328cases (40.5%)whose platelet count between (75～100)×109/L,271cases(33.5%) between (50～74.9)×109/L,145cases (17.9%) between (25～49.9)×109/L and66cases (8.1%) between(0～25)×109/L, but among414cases caused by HSD, those were65cases (15.7%),66cases(15.9%),81cases (19.6%),202cases (48.8%) at the same degree as that in NHSD. The degree of platelet decrease has statistically significant (P <0.05) between two different causeof TP.Ⅲ. Platelet indices varies1. Platelet hematocrit (PCT): PCT of1400cases were all lower, the average was (0.06±0.03)%. It is positively correlated between the PCT and the platelet count (R=0.825, P<0.001), and also with mean platelet volume (MPV)(R=0.200, P <0.001).2. Platelet distribution width (PDW): Among1400cases, there were787cases (56.2%)of increased PDW,538cases (38.4%) of normal PDW and75cases (5.4%) of reduced PDW.The PDW were all increase in25megaloblastic anemia (MA) cases, median was18.2(17.2-19.3)%, and it is positively correlated between PDW and PLT count (R=0.474, P<0.05). The patient’s PDW were no characteristic changes in the other diseases.3. Mean platelet volume (MPV): Observed the MPV of1400patients, there were70cases (5%) increased,1238cases (88.4%) normal,92cases (6.6%) lower. The Changes ofMPV in the different diseases were following:①Among39cases of aplastic anemia,30normal cases,9reduced cases;②Among34cases of bone marrow hyperplasia anomaliessyndrome,28normal cases and6reduced cases;③Among11cases of IDA,9normalcases and2reduced cases;④Among25cases of MA,23normal cases and2increasedcases of;⑤Among9cases of hemolytic anemia,8normal cases and1increased cases;(6)Among25cases of non-Hodgkin’s lymphoma, MPV are all normal;⑦28cases ofrheumatic diseases are all with normal MPV;⑧27cases of endocrine diseases are with24normal cases and3decreased cases;⑨Among46cases of circulatory system diseases,45cases of normal and1elevated cases;⑩Among19cases of pregnancy,18normal cases and1elevated cases.○11Others were no characteristic changes.Ⅳ. Relationship between PLT count and parts of laboratory examination1. Among54cases of TP caused by hepatitis B and C virus, there were28cases withincreased AST and18cases with increased ALT. PLT count and AST/ALT have nocorrelation.2. Among153cases of TP caused by infection, there were61cases with blood lactatedehydrogenase (LDH) increased, and the PLT count and serum LDH level are negativecorrelation (R=-0.288P=0.007). 3. Among134drugs-depended TP patients, there were97cases with blood LDHincreased, the PLT count serum LDH level have negative correlation(R=-0.528p=0.006);4. In90cases of TP caused by Renal insufficiency, PLT count and creatinine (CREA)level are positive correlation (R=0.261P=0.014), no correlation with the level of ureanitrogen.Ⅴ. Born marrow features1. Among1400TP cases, there were459cases with routine bone marrow examination(accounting for32.8%of all patients), including130cases (9.3%) caused by NHSD,309cases (22.1%) caused by HSD,20cases (1.4%)of unknown diagnosis.2. Among810NHSD cases, there were130cases with routine bone marrowexamination, including110cases of above active proliferation and20cases of lowerproliferation. The total number of megakaryocytes, there were15cases of more than150,less than7in24cases,91cases of normal number.3. Among169TP cases of unknown diagnosis, there were only20cases with routinebone marrow examination, including14cases of bone marrow hyperplasia active and6lower cases,13cases with normal total megakaryocytes number,7cases less than7.4. Among166patients of ITP, there were121patients underwent bone marrowexamination, including119cases of bone marrow were active hyperplasia and2cases werelow. And28cases of higher total megakaryocytes number greater than150,9cases less than7and84cases of normal number. The PLT count and the total megakaryocytic number werenegative correlation (R=-0.287, P=0.002).Ⅵ. Incidence of anemia and (or) leucopenia in TP caused by NHSD1. Among810cases caused by NHSD, there were58.6%(475cases) associated withanemia,52.5%(425cases) associated with leukopenia,36.9%(299cases) with both anemiaand leucopenia.2. The incidence of anemia: anemia incidence in90cases of renal insufficiency was83%(75cases),28cases of rheumatic diseases that was82%(23cases), two groups ofdiseases, anemia no statistical difference in probability, but compare the incidence of anemiabetween the above two groups of diseases and other diseases (hypersplenism, infection,drug-induced thrombocytopenia associated with hypersplenism hepatitis, circulatory systemdiseases, solid tumors, endocrine diseases and pregnancy),differences were foundsignificant (P <0.05). 3. Incidence of leucopenia: there were more than half of patients with leucopeniaamong rheumatic diseases, spleen hyperthyroidism, hepatitis not associated withhypersplenism, solid tumors and drug-induced thrombocytopenia, incidence of75%73%,66%,62%,54%.There is no significant difference incident between every two groups.4. The incidence of anemia and leucopenia in patients caused by NHSD, rheumaticdiseases was64%, drug-induced thrombocytopenia was51%,infected patients was48%,hypersplenism was47%, but there are no statistical significance of incidence between everytwo groups.Conclusion：1. There are lots of reasons can lead TP, non-blood system diseases are the main reason.2. NHSD can be first considered in that TP cases whose PLT count decreased Ⅰ~Ⅱdegree, but HSD should be suspected in those case whose PLT count decreased above Ⅲdegree.3. The changes of PDW and MPV in patients of TP have certain reference values thatcontribute to differential diagnosis.4. TP patients with lactic dehydrogenase increased, infection and (or) drug can be firstconsidered of the cause of TP.5. Patients with renal insufficiency may be associated with thrombocytopenia, plateletcount and severity of renal insufficiency are not parallel.6. The TP patients associated with anemia, that can often been seen in renalinsufficiency and rheumatic diseases as well as in HSD.7. The TP patients associated with anemia and leucopenia, in addition to the diseases ofthe blood system we should pay attention to drugs, infection and spleen hyperfunction.8. Among the cases of TP caused by Non-blood system diseases, there are notsignificant characteristic changes with bone marrow examination.