Тромбоцитами называют кровяные клетки в форме округлых пластинок, у которых нет ядер. И увеличение их количества в кровотоке, и сниженное количество тромбоцитов опасно для здоровья ребенка. По этой причине родителям следует знать, что это за клетки крови, сколько их должно быть в норме и почему число тромбоцитов может меняться.
Зачем они нужны?
Такие кровяные клетки играют большую роль для системы свертывания крови.
Благодаря им, при повреждении сосудов кровотечение останавливается, а сам участок повреждения закрывается тромбом. Кроме того, на своей поверхности кровяные пластинки переносят разные биологически активные соединения, иммунные комплексы, а также факторы свертывания.
Кровяные пластинки образуются в красном костном мозге, а после выхода в кровоток время их жизни составляет от двух до десяти суток, после чего тромбоциты переносятся к селезенке, где и разрушаются. В это время в кровеносное русло непрерывно поступают новые клетки. Таким образом, тромбоциты постоянно обновляются, и их общее количество остается примерно на одном уровне.
Как определяют число тромбоцитов?
Оценку количества тромбоцитов проводят по клиническому анализу крови. Это исследование все врачи называют самым важным в детском возрасте. Для его проведения кровь у ребенка можно брать из пальца, а также из вены. Самым маленьким деткам забор крови может выполняться из пяточки. Тромбоциты подсчитывают в литре крови, обозначая их в бланке анализа в 10 9 /л.
Анализ крови могут назначать ребенку планово, даже если у него нет каких-либо жалоб.
Внеплановое направление на анализ дают деткам, у которых появляется кровоточивость десен, эпизоды кровотечений из носа, длительно не останавливающееся кровотечение после пореза, частое появление синяков, жалобы на усталость, боли в конечностях и прочие недомогания.
Также тромбоциты обязательно проверяют при анемии, увеличении селезенки, лейкозе, вирусных инфекциях, системных и других заболеваниях, способных спровоцировать изменение числа этих клеток крови.
Что влияет на их количество?
Число кровяных пластинок зависит от:
- Возраста ребенка. У новорожденных их больше, чем у грудничков старше месяца и более взрослых деток.
- Наличия заболеваний, а также приема лекарственных средств.
- Физической нагрузки. В течение некоторого времени после нее число кровяных пластинок становится выше.
- Питания ребенка. Существуют продукты, способные разжижать кровь, а некоторая пища стимулирует образование кровяных клеток.
- Времени суток, а также времени года. В течение дня наблюдают колебание количества тромбоцитов в пределах 10%.
Чтобы результат анализа крови был достоверным, а число тромбоцитов в бланке анализа отвечало реальному количеству клеток в крови, важно соблюдать такие рекомендации:
- Ребенок не должен употреблять пищу перед забором крови. Если образец крови берут у грудничка, перерыв между кормлением и манипуляцией должен составлять 2 часа.
- Перед анализом у ребенка не должно быть эмоциональных или физических нагрузок. Немаловажно и правильно подобрать ребенку одежду, чтобы избежать переохлаждения. Также не рекомендуется сдавать кровь сразу после того, как ребенок зашел в поликлинику с улицы. Пусть он 10-15 минут отдохнет в коридоре и успокоится.
- Если ребенку уже проводится какое-либо лечение, перед сдачей крови обязательно предупредите врача о том, что вы принимаете лекарства, поскольку они могут сказаться на общей картине.
Таблица по возрасту
Норма уровня тромбоцитов у детей представлена такими показателями:
Возраст ребенка
Количество тромбоцитов в 10 9 /л
Тромбоцитарные безъядерные клетки выполняют две важнейшие функции в организме: формируют кровяной сгусток в тех местах, где есть повреждение целостности сосуда и его кровоточивость, а также укрепляют сосудистые стенки, делая их эластичными. Содержание тромбоцитов в крови, которое находится в пределах нормы, говорит о правильном функционировании костного мозга, где эти клетки и синтезируются. Мегакариоциты, из плазмы которой формируются тромбины, не всегда справляются со своей задачей, поэтому в крови появляется дисбаланс. Если тромбоцитов больше, чем это нужно организмы, то высока вероятность развития тромбоза, при котором обильно формирующиеся кровяные сгустки способны перегораживать просвет сосуда, нарушая естественный кровоток. Когда отмечается недостаток этих пластинчатых телец, кровь не имеет нужной консистенции, поэтому не способна сворачиваться при развитии кровотечения, что не менее опасно, и грозит обильными потерями крови, опасными для жизни.
Так или иначе, но нормальный уровень тромбоцитов в крови, особенно у детей, должен постоянно контролироваться. Малейшие отклонения должны быть исследованы и изучены. Чем раньше заметен дисбаланс, тем больше шансов его успешной корректировки. Каковы нормы тромбоцитов в детском возрасте, а также о чем свидетельствуют отклонения, разберем далее.
Роль тромбоцитов в детском организме
При рождении ребенок получает свой уникальный состав крови, который во многом схож с материнским набором. Определить тромбоцитарный уровень позволит обычный анализ крови, который берут из пуповинной крови или из пальца. Стоит понимать, что с постепенным развитие систем и функций организма может меняться количественный и качественный состав крови. Это объясняется работой и формированием надпочечников, гормоны которых помогают регулировать процесс синтеза мегакариоцитами тромбоцитов. Поэтому на протяжении от рождения и до половозрелости нормой могут считаться абсолютно разные показатели.
Рассмотрим на примере, как тромбоциты у детей зависят от стадий развития ребенка:
- При рождении сохраняются самые примитивные рефлексы, а функции организма лишь начинают устанавливаться. На фоне активного роста и развития разброс в показателях нормы максимален.
- В период от года до 3 лет, когда ребенок активно познает мир, учится ходить, разговаривать и осознавать себя как личность, организмом управляют гормоны, под действием которых появляется необходимость в интенсивной выработке тромбоцитов. Эта естественная защитная функция позволит избежать обильных кровотечений при падениях (научиться ходить без них невозможно), а также оградит от ломкости сосудов, которая проявляется в виде гематом при незначительных ушибах.
- Когда ребенок становиться чуть старше, показатели нормы приближаются к взрослым, однако в период гормональной перестройки (12-15 лет) допускаются погрешности по 15-20% отклонений в каждую сторону.
Важно контролировать уровень тромбоцитов в первый год жизни, поскольку именно в этот период закладываются механизмы поддержания здоровья и иммунитета. Помочь в данном процессе способен анализ крови, который рекомендуется сдавать не реже 1 раза в триместр.
Значения нормы у детей
Чтобы разобраться, какие показатели считаются нормальными для того или иного возраста, представлена таблица, где отображены все данные. Показатели приводятся в тысячах на один миллилитр крови.
| Возраст | Показатель нормы |
| у новорожденных | 170-480 |
| 1-3 месяца | 180-440 |
| 3-6 месяцев | 180-410 |
| 6-12 месяцев | 180-400 |
| 1-2 года | 170-390 |
| 2-3 года | 170-360 |
| 3-5 лет | 165-375 |
| 5-7 лет | 160-380 |
| 7-10 лет | 160-375 |
| 10-13 лет | 165-390 |
| 13-15 лет | 160-400 |
| 15-16 лет | 160-360 |
| 16-18 лет | 160-400 |
Наличие погрешностей в детском возрасте, а также увеличение разрыва в показателях – это вынужденная мера, основанная на результатах ряда исследований. Особенно это касается периода гормональной перестройки, когда в здоровом организме при гормональном дисбалансе может отмечаться разница в количестве продуцируемых тромбоцитов. Тромбоциты у грудничка имеют максимально высокий уровень погрешности, что говорит о незрелости костного мозга и гормональной системы.
Анна Поняева. Закончила нижегородскую медицинскую академию (2007-2014) и Ординатуру по клинико-лабораторной диагностике (2014-2016).Задать вопрос>>
Отклонениями считаются показатели результата анализа, которые выходят за границы общеустановленных норм. Если они незначительные, то предлагают пересдать анализ. Но в случае, если тромбоцитарный дисбаланс подкрепляется наличием отклонений со стороны других фракций крови (повышены лейкоциты) – есть вероятность наличия проблем со здоровьем.
Повышенные значения
В большинстве случаев увеличение числа тромбоцитарных клеток связано с наличием воспалительного процесса в организме, поскольку их синтез сочленен с выработкой лейкоцитов. Тромбоциты – это своего рода помощники лейкоцитов, которые помогают укрепить клеточные мембраны и не допустить проникновения в них патогенных бактерий. Такое состояние может наблюдаться при ОРЗ и ОРВИ, однако причины могут быть и посерьезнее.
Дело в том, что множество заболеваний, которые развиваются на фоне увеличенных тромбоцитов, не дают о себе знать достаточно длительное время, протекая бессимптомно. Проблемы диагностируются случайно, при проведении планового анализа крови.
Причины и симптомы
Повышенный уровень тромбоцитов называется тромбоцитозом, причинами которого могут быть следующие проявления:
- онкологические заболевания, связанные с кроветворными органами;
- наличие хронических заболеваний, провоцирующих воспаление не только самого органа, но и близ лежащих тканей: гепатит, туберкулез, цирроз печени, менингит;
- вирусное поражение крови менингококками, стрептококками, стафилококками: остеомиелит, подагра, артроз, ревматизм;
- дефицит железа;
- длительный прием антибактериальных, противовирусных и противогрибковых медикаментов, влияющих на иммунитет.
Первичные симптомы тромбоцитоза не имеют внешних проявлений, но при прогрессировании заболевания симптоматика может заключаться в таких ситуациях:
- наличие крови в кале и моче;
- кожный зуд без видимых высыпаний;
- холод в конечностях даже в летние месяцы;
- частые приступы головной боли, головокружение и потеря сознания без причин;
- симптомы вегето-сосудистой дистонии;
- тахикардия на фоне прогрессирующей аритмии;
- наличие тромбов в крови, внешне проявляется посинением определенного участка кожи, а также четкое просматривание очертания сосудов через кожный покров.
Особенности лечения и профилактика
Как вспомогательное средство используют препараты, разжижающие кровь (Аспирин, Аспаркам, Аспирин-Кардио, Кардиомагнил). Нужно помнить, что разжижение крови неестественным способом при помощи синтетических веществ может иметь массу побочных реакций, особенно в детском возрасте.
В случаях, когда уровень тромбоцитов превышает предельно допустимые значения в 2-3 раза – проводится экстренная терапия. Для этого используют процедуру фильтрации собственной крови (гемодиализ). Детскую кровь пропускают через специальный аппарат, который способен задерживать тромбоциты, оставляя основной состав крови прежним. Процедура производится в стерильных условиях, а также способна спасти жизнь в критических ситуациях.
В качестве профилактики, а также вспомогательного метода лечения используют диету. Детям не рекомендовано большое содержание углеводов, а также жиров животного происхождения (за исключением молочной продукции). Рацион составляют каши, овощи (свежие и на пару), кисели из свежих фруктов и ягод. Хорошо помогают снизить тромбоциты такие продукты, как:
Сделать кровь не такой концентрированной поможет обильное питье. Ребенку предлагают пить кипяченую воду, в объеме 30 мл на каждый килограмм веса. Пить следует небольшими глотками, но часто (каждые 15-20 минут).
Пониженные значения
Ее опасность заключается в неспособности крови свертываться при наличии механического повреждения целостности сосуда. От большой потери крови ребенок может умереть, поэтому не стоит недооценивать серьезность такой патологии. Показатели ниже нормы должны быть обследованы и нормализованы.
Причины и симптомы
Тромбоцитопения может развиваться в случае активизации таких негативных факторов, как:
- гормональные нарушения;
- рак крови, при котором мегакариоциты полностью утрачивают свои функции;
- недостаток в организме важных витаминов и минералов: витамины группы В, фолиевая кислота, калий, магний, фосфор;
- наличие ярко выраженной аллергической реакции;
- ангионевротический отек наследственного типа;
- сильная интоксикация организма в результате продолжительного функционирования инфекций, вирусов и грибков;
- аутоиммунные заболевания;
- расстройства психики;
- физическая перенагрузка.
Определить тромбоцитопению гораздо проще, нежели тромбоцитоз.
Первый симптом проблем со свертываемостью крови – это кровоточивость из носа, а также появление гематом и синяков без причин. Также кровоточивость может развиваться на внутренних органах, а обычное чихание приведет к выделению крови из носоглотки.
Лечение и профилактика
Лечение в данном случае направлено на стимуляцию выработки тромбоцитов. Если терапевтического эффекта от произведенного лекарственного лечения не отмечается, требуются более радикальные меры. Наиболее продуктивным лечением является:
- вливание донорских тромбоцитов в организм, наличие которых может простимулировать гормональную систему и кариоциты к синтезу собственных клеток;
- пересадка костного мозга, что является дорогостоящей но самой эффективной процедурой в том случае, когда проблема низких тромбоцитов напрямую связана с клеткам костного мозга.
В целях профилактики детям, имеющим предпосылки развития тромбоцитопении, рекомендуют придерживаться специальной диеты, которая делает кровь более насыщенной:
- красное мясо;
- рыба;
- субпродукты: печень, почки, сердца.
Исключают из рациона любые блюда, содержащие красители и консерванты.
Таким образом, в детском возрасте на фоне гормональных изменений может отмечаться дисбаланс тромбоцитарных клеток, что опасно для жизни. Зачастую определить наличие этой проблемы визуально невозможно. Снизить риск развития серьезных патологий и проблем со здоровьем позволит плановый осмотр у педиатра, а также сдача крови не реже 1 раза в триместр. При тревожных симптомах частота проведения анализа может быть увеличена.
Контролирование детского здоровья возможно, благодаря плановым посещениям терапевта. Чтобы обследовать ребенка, помимо визуального осмотра, врач периодически назначает анализ крови. Лабораторное исследование состояния форменных клеток в русле крове дает полную картину наиболее жизненно важных процессов, происходящих в детском организме. К одним из таких элементов кровяного потока относятся тромбоциты, выполняющие незаменимую функцию в теле человека. Какая норма тромбоцитов у детей должна быть для полноценного функционирования всех систем организма ребенка.
Предназначение тромбоцитов
Численность тромбоцитов в единице объема кровяного русла отмечается в лабораторных бланках аббревиатурой PLT, которая в развернутом определении Platelets означает «пластинка». Тромбоциты представляют собой самые мелкие, примерно 2–4 мкм, бесцветные и безъядерные, плоские кровяные клетки округлой формы с выростами. Они формируются в центральном органе кроветворения, которым является костный мозг. Большая доля кровяных пластин, как их еще называют, приблизительно 75% попадает в кровь, а некоторая незначительная часть около 25% накапливается в селезенке. В этом органе, а также частично в печени, происходит уничтожение отслуживших тромбоцитов, срок непродолжительной жизни которых колеблется от 8 до 12 дней.
Роль тромбоцитов очень важна, они ответственны за:
- Выделение факторов свертывания плазмы крови для образования тромбов в местах повреждения наружных или внутренних мягких тканей.
- Производство факторов роста для регенерации стенок сосудов кровеносной системы.
- Питание стенок кровеносных сосудов, за счет снабжения их биологически активными веществами.
- Перенесение иммунных комплексов в воспалительные очаги для их ликвидации.
- Очищение кровяного русла от вредоносных микроорганизмов, уничтоженных путем связывания их с антителами.
Синтез тромбоцитов происходит непрерывно — одновременно в кровяном русле могут соседствовать клетки, находящиеся в разной возрастной стадии. Возрастные периоды тромбоцитов принято подразделять на пять форм: в юной фазе, в стадии зрелости, состарившиеся, в промежуточном отрезке раздраженности, на этапе дегенеративности.
Основную массу тромбоцитов, которым надлежит выполнять свое предназначение, должны составлять клетки, находящиеся в зрелом состоянии.
Следовательно, количественное значение полноценных тромбоцитов, находящихся в активной стадии дееспособности, может варьироваться как в плюсовую, так и в минусовую сторону ориентировочно на 10%. В идеальном состоянии организм способен поддерживать баланс между отслужившими и вновь прибывшими плоскими тельцами. Именно в целях поддержания либо при необходимости восстановления данного равновесия, педиатры регулярно назначают анализ крови.
Допустимый показатель тромбоцитов в детском возрасте
Коэффициент тромбоцитов в крови у ребенка может изменяться в течение дня. Этот показатель имеет довольно широкий числовой диапазон. Поэтому принимать меры стоит только при сильных отклонениях от нормы, в остальных случаях незначительные изменения в ту или иную сторону могут быть связаны с различными физиологическими факторами.
Кардинальное отклонение от нормы плоских кровяных телец, как в зону уменьшения, так и в область увеличения, одинаково свидетельствует о патологии. Но об этом можно рассуждать только, если верхний порог заходит за 480 000 микролитров, а нижний опускается за пределы 100 тысяч мкл. В остальных случаях паниковать не стоит, но при систематических, даже не особо существенных колебаниях plt в анализе крови, необходимо обязательно выявить причину подобных изменений.
Норма тромбоцитов в крови у детей в процессе роста увеличивается. Различие полов не оказывает существенного влияния на данные показания вплоть до совершеннолетия. Уровень тромбоцитов в крови рассчитывается на литр кровяной субстанции.
Нормальный показатель plt в кровяном потоке в детском возрасте. Таблица.
| Возраст ребенка | Числовой диапазон тромбоцитов в русле крови (измеряется в микролитрах) |
|---|---|
| Первая неделя после рождения | 100–480 |
| С недельного возраста до половины первого месяца | 150–480 |
| От 1 до 2 месяцев | 160–450 |
| С 2 до 5 месяцев | 180–420 |
| С 6 до 12 месяцев | 180–410 |
| С 1 года до 2 лет | 160–380 |
| С 2 до 5 лет | 160–375 |
| С 6 до 8 лет | 165–375 |
| С 9 до 13 лет | 165–380 |
| С 14 до 18 лет | 160–360 |
Проследив рост показаний plt, заметно, что дети в первые 2 года интенсивного развития стремительно увеличивают численность плоских кровяных клеток, предназначенных для свертывания крови и прочих важных функций. В этом периоде для детей норма тромбоцитов достигает максимального уровня, особенно нижняя граница. В возрасте около 6 лет, уже повзрослевший малыш, стабилизирует показатель нижнего порога на 160 тысячах мкл и верхнего предела на 380 тысячах микролитров, и так вплоть до полного взросления.
Чтобы выяснить индекс тромбоцитов в крови ребенка, необходимо сдать общий анализ крови в районной поликлинике или диагностическом центре. Проводить исследование форменных клеток кровяного русла рекомендуется хотя бы раз в год, но не реже. У детей все жизненно важные процессы протекают очень быстро как положительные, так и, к сожалению, отрицательные. Поэтому польза от своевременного обследования невероятно велика.
Тромбоцитоз | последствия и причины возникновения
Значительное превышение plt в анализе крови именуется тромбоцитозом. Заболевание характеризуется большим, чем нужно, количеством безъядерных клеток в кровяном потоке, что приводит к его вязкости и сгущению. Густая кровь не способна полноценно циркулировать. К тому же форменные частицы собственной массой в виде сгустков крови (тромбов) забивают проходы в капиллярах и сосудах кровеносной системы, что может привести к множеству проблем в функционировании различных органов и систем растущего организма.
В зависимости от причины возникновения, тромбоцитоз может быть:
- Первичный. Он возникает при нарушении синтеза тромбоцитов в главном органе кроветворения.
- Вторичный. Проявляется при развитии патологий, таких как злокачественные опухоли, инфекции разной этимологии, повреждения в функционировании кровеносной и сердечно-сосудистой систем. Вдобавок может возникнуть на фоне нехватки железа, повреждения органов, в результате приема определенных медикаментов, при усиленных физических нагрузках. А также после проведения оперативных вмешательств на селезенке или печени.
Тромбоцитопения | чем чревато и этиология
Если клинический анализ крови показывает повышенные тромбоциты у детей, то это состояние называется тромбоцитопенией. Это опасное заболевание, так как сильно затрудняет остановку кровотечения. Проявляется синяками на теле, долго заживающими повреждениями мягких тканей, кровоточивостью десен, носовыми кровоизлияниями. Признаки явно свидетельствуют о недостаточной свертываемости крови. Появление хотя бы одного симптома тромбоцитопении должно привлечь внимание родителей, после чего нужно незамедлительно обратиться к педиатру.
Понижение уровня тромбоцитов наблюдается:
- у недоношенных деток;
- у малышей перенесших асфиксию при родах;
- у детей с недостаточной массой тела;
- с ослабленными защитными силами организма;
- при анемии вследствие авитаминоза;
- при продолжительном кровотечении;
- если проводилось лечение антибиотиками;
- в результате наследственности ребенка;
- в случае перенесения инфекций;
- в связи с онкологией, патологией щитовидной железы и в некоторых других ситуациях.
Существует три основные причины снижения plt в крови:
- При уменьшении производства тромбоцитов в костном мозге.
- При интенсивном их уничтожении.
- При неправильном их распространении.
Если индекс plt сильно занижен, потребуется лечение в стационаре, потому как с подобным отклонением существует серьезный риск для жизни. Когда показатель уровня тромбоцитов снижен незначительно — это может сигнализировать о недостатке некоторых питательных веществ. Как только питание будет восполнено, плоские клетки крови тут же придут в норму.
Общий анализ крови по праву можно отнести к универсальной процедуре — это как будто амбулаторная карта всего организма. Необходимо помнить только, что правильная крови расшифровка, может быть дана только профессиональным врачом. Опытный специалист способен не только грамотно интерпретировать полученные из лаборатории показания тромбоцитов в крови, но и сопоставить индекс plt в совокупности с другими форменными клетками. И уже, исходя из общей клинической картины, дать рекомендации относительно дальнейших действий по восстановлению или поддержанию нужного уровня тромбоцитов в крови у детей.
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