血小板减少症的诊断检查手段有哪些？

印度代购提示您，必须彻底弄清病人的服药史，以排除对敏感病人增加血小板破坏的药物。约5%接受肝素治疗的患者可发生血小板减少，为保持动静脉输注导管通畅，即使应用极少量肝素冲洗，也可发病。其他药物较少诱发血小板减少症，例如奎尼丁，奎宁，磺胺制剂，口服抗糖尿病药，金盐以及利福平。

A patient's medication history must be thoroughly established to rule out drugs that increase platelet destruction in sensitive patients. Thrombocytopenia occurs in about 5% of patients treated with heparin, and can occur even with minimal heparin flushing to keep arteriovenous catheters open. Other drugs are less likely to cause thrombocytopenia, such as quinidine, quinine, sulfonamide, oral antidiabetic drugs, gold salts, and rifampicin.

　　印度代购提示您，病史中还有很重要的内容，病史中可能引出提示免疫性基础疾病的症状(例如关节疼痛，雷诺氏现象，不明热);提示血栓性血小板减少症的体征与症状;10天之内输过血提示可能是输血后紫癜，大量饮酒提示酒精所致血小板减少症。5%孕妇分娩期可发生轻度血小板减少症。由于感染人类免疫缺陷性病毒(HIV)的患者常伴血小板减少症，可与特发性血小板减少性紫癜症相鉴别;由此可以得出其他HIV感染症状的危险因素和病史。

　　印度代购提示您，体检对诊断亦很重要：

　　(1)通常继发于感染性或活动性系统性红斑狼疮(SLE)的血小板减少症以及血栓性血小板减少症(TTP)时有发热，而在特发性血小板减少性紫癜(ITP)以及与药物有关的紫癜则不发热。

　　(2)由于血小板的破坏增加(例如特发性血小板减少性紫癜，与药物有关的免疫性血小板减少症，血栓性血小板减少性紫癜)而引起的血小板减少症病人的脾脏扪诊不增大;而继发于脾脏对血小板阻留的血小板减少症患者的脾脏大多可以扪及，继发于淋巴瘤或骨髓增生性疾病的血小板减少症病人也是如此。

　　(3)其他慢性肝病的体征对诊断也有意义，如蜘蛛痣，黄疸和肝掌。

　　(4)妊娠末期常引起血小板减少症。

　　外周血细胞计数是确定血小板减少症及其严重性的关键性检查，同时血涂片检查能为其病因检查提供线索。若血小板减少不伴有其他影响止血功能的疾病(例如肝脏疾病或弥散性血管内凝血)，止血功能筛选检查则是正常的。骨髓象检查若在血涂片上见到除血小板减少以外的异常，有本检查适应证。本检查可提供巨核细胞的数量及形态的信息，并确定有或无引起骨髓功能衰竭疾病(例如骨髓异常增生)的存在。抗血小板抗体检查临床意义不大。若患者病史或检查提供HIV感染危险依据，应对其进行HIV抗体检查。

Peripheral blood cell count is the key test to determine the severity of thrombocytopenia, and blood smear can provide clues for the etiology of thrombocytopenia. Screening for hemostasis is normal if thrombocytopenia is not associated with other diseases that affect hemostasis, such as liver disease or disseminated intravascular coagulation. If abnormalities other than thrombocytopenia are seen on blood smears during bone marrow examination, there are indications for this examination. This test can provide information on the number and morphology of megakaryocytes and determine the presence or absence of diseases causing bone marrow failure, such as myelodysplasia. Antiplatelet antibody test has little clinical significance. If the patient's history or examination provides evidence of risk for HIV infection, he/she should be tested for HIV antibodies.