#1
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ÌÄÑ
Çäðàâñòâóéòå, Âàäèì Âàëåðüåâè÷! Ïðîøó, ïîæàëóéñòà, íå áàíüòå ìåíÿ. Õî÷ó ïðîñòî óçíàòü, êàê èñêëþ÷èòü ðåôðàêòåðíóþ òðîìáîöèòîïåíèþ â ðåçóëüòàòå ÌÄÑ?
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#2
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åòèì çàíèìàåòñÿ î÷íûé ãåìàòîëîã, âû ñàìè ñåáå íå èñêëþ÷èòå, ÷òî âàì íåïîíÿòíî ñ ïðîøëîé òåìû? âàøà ïðîáëåìà â ÷òåíèè, èñêëþ÷èòå ó ñåáÿ ðåôðàêòåðíóþ T-ïåíèþ èç-çà ìåòàñòàçîâ â êîñòíûì ìîçã? èç-çà àïëàçèè ÊÌ ïî äðóãèì ïðè÷èíàì?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ìíå â áîëüíèöå ñêàçàëè, ÷òî î÷åíü ÷àñòî â âîçðàñòå 60 ëåò è ñòàðøå èçîëèðîâàííàÿ òðîìáîöèòîïåíèÿ ñâÿçàíà ñ ÌÄÑ, êîãäà äèñïëàçèÿ ïðîèñõîäèò â îäíîì ðîñòêå. À àóòîèììóííàÿ - â ìîëîäîì.
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#4
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Âû â Íàâèíêàõ áûëè? òîëüêî òàì òàê ìîãëè ñêàçàòü
Many epidemiological studies have shown that the incidence of immune thrombocytopenia (ITP) increases after age 60 years and peaks in patients over age 80 years.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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Ýòî â öåíòðå ãåìàòîëîãèè íà áàçå 9 áîëüíèöû ñêàçàëè
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#6
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âñÿ ÐÁ îò ñàìîãî ãëàâíîãî çàñòðÿëè â ïðîøëîì âåêå, òàê ÷òî êàêîâ ïîï ó âëàñòè òàêîé è ïðèõîä â ãåìàòîëîãè÷åñêîé áîëüíèöå - îïåðèðóþò äàííûìè ñîâåòñêîé ìåäèöèíû, à âî âñåì ìèðå îíà óøëà âïåðåä
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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ÌÄÑ - åòî ãåìàòîëîãè÷åñêîå çàáîëåâàíèå, è ãåìàòîëîãè íå ìîãóò ãîâîðèòü "èñêëþ÷àòü åãî" â äîì. óñëîâèÿõ, åòî êàê ïîæàëîâàòüñÿ íà ãåìîððîé ïðîêòîëîãó, à îí Âàñ îòïðàâèò ê ãàñòðîåíòåðîëîãó, ÌÄÑ èëè äðóãèå ïðîáëåìû âûðàáîòêè Òð èñêëþ÷àþòñÿ áèîïñèåé/àíàëèçîì êîñòíîãî ìîçãà, êîòîðóþ ïðîâîäÿò èñêëþ÷èòåëüíî ãåìàòîëîãè
Another differential diagnosis of thrombocytopenia in older patients is myelodysplastic syndrome (MDS) affecting megakaryocyte lineage. Although most MDS cases exhibit associated thrombocytopenia (65%),13 isolated thrombocytopenia is less frequent (12% of cases).14 Therefore, the presence of other cytopenia or macrocytosis on complete blood count and signs of dyserythropoiesis and/or dysgranulopoiesis on peripheral blood smear examination should prompt a BME to rule out a myelodysplastic syndrome.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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#8
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Òàê îíè è ãîâîðÿò, ÷òî íóæíî ïðîâåñòè áèîïñèþ ñðàçó, ïîòîìó ÷òî àóòîèììóííàÿ âñòðå÷àåòñÿ â ìîëîäîì è äåòñêîì âîçðàñòå è ñêîðåå âñåãî ýòî ÌÄÑ, ïîýòîìó ëó÷øå ñðàçó íà÷àòü ñ áèîïñèè, à íå ñäàâàòü êó÷ó àíàëèçîâ.
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#9
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âàì ãîâîðþ, ÷òî åòî àðòåôàêòíàÿ òðîìáîöèòîïåíèÿ = íå èñòèííàÿ, íî âû íå ñîãëàñíû - òàê ÷òî âûáåðèòå ÷òî âàì áîëüøå íðàâèòñÿ, ëè÷íî ÿ íå õîòåë áû ÷òîáû ðàäè ëþáîïûòñòâà âðà÷åé â ìåíÿ òûêàëè èãîëêîé, à ìîæåò âàì åòî íðàâèòñÿ, êîãäà ñ âàìè ÷òî-òî äåëàþò;
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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è åøå äàæå åñëè áû ó âàñ áûëà èñòèííàÿ, áèîïñèÿ òîëüêî íàõîäèò îòêëîíåíèÿ è êàæäîãî 1:200
Performing systematic BME in patients >60 years presenting isolated thrombocytopenia has been debated in the past years. However, growing evidence suggests that the rate of abnormality on bone-marrow smear in this context is very low. In the prospective French registry, only one in 197 (0.5%) patients with ITP and older than 60 years had an abnormal bone-marrow smear result.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
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Ñåãîäíÿ çâîíèëà â èíâèòðî, ìíå îíè ñêàçàëè, ÷òî îøèáêà íåâîçìîæíà, ïîòîìó ÷òî îíè ïî ìàçêó ïðîâåðÿëè ïîñëå àíàëèçàòîðà
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#12
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åøå ðàç ìíå âñå ðàâíî, ÷òî ãîâîðÿò â èíâèòðî, ìîæåò ó âàñ ñëèïàíèå ñ ëþáûì àíòèêîàãóëÿíòîì, ïðè èñòèííîé âåçäå âñåãäà îäíî è òîæå ÷èñëî òðîìáîöèòîâ åñëè 50, òî ó âñåõ áóäåò ãäå-òî 40-60 â ðàçáðîñå, åñëè â îäíîì 5 à äðóãîì 70, à òðåòüåì 120, òî åòî àðòåôàêò, åñëè ó æåíùèíû ðàçìåð ãðóäè íîëü - îí áóäåò ðàçíûé â çàâèñèìîñòè îò èçìåðèòåëÿ?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#13
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çàíåñèòå â èíâèòðî åòó èíôó - åñëè îíè êðóòíóò íà âîðòåêñå, òî ÷èñëî òðîìáîöèòîâ óâåëè÷èâàåòñÿ â 2 ðàçà; ïîíèìàþ ÷òî íåò ó íèõ äð. âîçìîæíîñòåé, íî âîðòåêñ åñòü âåçäå
A Vortex Method to Disaggregate Platelets for Correct Counting in Pseudothrombocytopenia [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#14
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Õîðîøî, ñïàñèáî áîëüøîå çà òåðïåíèå. Îíè ñîãëàñèëèñü âçÿòü àíàëèç ñ öèòðàòîì, íà ñëåä íåäåëå ñäàì.
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#15
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òîëüêî ïóñòü ñäåëàþò è ñ åäòà è ñ öèòðàòîì âìåñòå è â òå÷åíèå ïåðâûõ 10-15 ìèíóò îò êðîâåçàáîðà, åñëè â åäòà áóäåò 60, à â öèòðàòå 120 - åòî ëîæíàÿ ÒÏ, â öèòðàòå òîæå ìîæåò íå áûòü íîðìà à 120-140, ãëàâíîå - ðàçíèöà ìåæäó èçìåðåíèåì òàì è òàì
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |