Zvýšené trombocyty: příčiny, norma a kdy je to závažné
Krevn\u00ed obraz uk\u00e1zal zv\u00fd\u0161en\u00e9 trombocyty a nev\u00edte, co to znamen\u00e1? Trombocyt\u00f3za \u2013 zv\u00fd\u0161en\u00fd po\u010det krevn\u00edch desti\u010dek \u2013 m\u00e1 nej\u010dast\u011bji zcela ban\u00e1ln\u00ed p\u0159\u00ed\u010dinu. Ale v n\u011bkter\u00fdch p\u0159\u00edpadech m\u016f\u017ee signalizovat z\u00e1va\u017en\u011bj\u0161\u00ed onemocn\u011bn\u00ed. Tento \u010dl\u00e1nek se zam\u011b\u0159uje na zv\u00fd\u0161en\u00e9 hodnoty. Kompletn\u00ed p\u0159ehled norem v\u010detn\u011b n\u00edzk\u00fdch hodnot najdete v \u010dl\u00e1nku Trombocyty norma.
Obsah článku
Co jsou trombocyty a jakou maj\u00ed funkci
Trombocyty (krevn\u00ed desti\u010dky) jsou mal\u00e9 bezjadern\u00e9 bu\u0148ky, kter\u00e9 vznikaj\u00ed v kostn\u00ed d\u0159eni z megakaryocyt\u016f. Jejich hlavn\u00ed \u00fakol je sr\u00e1\u017een\u00ed krve \u2013 p\u0159i poran\u011bn\u00ed c\u00e9vy se rychle shlukuj\u00ed v m\u00edst\u011b po\u0161kozen\u00ed, tvo\u0159\u00ed z\u00e1tkuj\u00edc\u00ed sra\u017eeninu a zastavuj\u00ed krv\u00e1cen\u00ed. Bez trombocyt\u016f by ka\u017ed\u00e9 drobn\u00e9 poran\u011bn\u00ed bylo \u017eivotu nebezpe\u010dn\u00e9.
Od jak\u00e9 hodnoty jde o zv\u00fd\u0161en\u00e9 trombocyty
Norma trombocyt\u016f je 150\u2013400 \u00d7 10\u2079/l. O trombocyt\u00f3ze mluv\u00edme p\u0159i hodnot\u00e1ch nad 400 \u00d7 10\u2079/l. Rozsah a p\u0159\u00ed\u010dina zv\u00fd\u0161en\u00ed z\u00e1sadn\u011b ovliv\u0148uj\u00ed, jak z\u00e1va\u017en\u00fd n\u00e1lez je. (Podrobn\u00e9 normy podle v\u011bku a pohlav\u00ed v\u010detn\u011b n\u00edzk\u00fdch hodnot \u2192 Trombocyty norma.)
Co znamenaj\u00ed zv\u00fd\u0161en\u00e9 trombocyty \u2013 podle hodnoty
| Hodnota (\u00d7 10\u2079/l) | Stupe\u0148 | Nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010diny |
|---|---|---|
| 400 \u2013 600 | M\u00edrn\u00e1 trombocyt\u00f3za | Infekce, z\u00e1n\u011bt, nedostatek \u017eeleza, po operaci |
| 600 \u2013 1 000 | St\u0159edn\u00ed trombocyt\u00f3za | Chronick\u00fd z\u00e1n\u011bt, autoimunitn\u00ed onemocn\u011bn\u00ed, reaktivn\u00ed p\u0159\u00ed\u010diny |
| Nad 1 000 | Z\u00e1va\u017en\u00e1 trombocyt\u00f3za | Esenci\u00e1ln\u00ed trombocyt\u00e9mie, myeloproliferativn\u00ed onemocn\u011bn\u00ed |
Reaktivn\u00ed trombocyt\u00f3za \u2013 nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dina
P\u0159es 80 % p\u0159\u00edpad\u016f zv\u00fd\u0161en\u00fdch trombocyt\u016f je reaktivn\u00ed \u2013 trombocyty stoupaj\u00ed jako p\u0159irozen\u00e1 reakce t\u011bla na jin\u00fd stav. Kostn\u00ed d\u0159e\u0148 sama o sob\u011b funguje spr\u00e1vn\u011b, jen reaguje na sign\u00e1l z t\u011bla.
Nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010diny reaktivn\u00ed trombocyt\u00f3zy
- Infekce a z\u00e1n\u011bt \u2013 bakteri\u00e1ln\u00ed infekce (z\u00e1pal plic, infekce mo\u010dov\u00fdch cest) a chronick\u00e9 z\u00e1n\u011bty (revmatoidn\u00ed artritida, Crohnova choroba, IBD) jsou nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dinou; trombocyty stoupaj\u00ed jako sou\u010d\u00e1st syst\u00e9mov\u00e9 z\u00e1n\u011btliv\u00e9 odpov\u011bdi spolu s CRP
- Nedostatek \u017eeleza (sideropenick\u00e1 an\u00e9mie) \u2013 jeden z nej\u010dast\u011bj\u0161\u00edch a nejp\u0159ekvapiv\u011bj\u0161\u00edch d\u016fvod\u016f; p\u0159i n\u00edzk\u00e9m ferritinu kostn\u00ed d\u0159e\u0148 paradoxn\u011b zvy\u0161uje produkci trombocyt\u016f; hodnoty typicky 500\u2013700. Viz ferritin
- Po operaci nebo traumatu \u2013 trombocyty stoupaj\u00ed 7\u201314 dn\u00ed po chirurgick\u00e9m v\u00fdkonu jako sou\u010d\u00e1st hojen\u00ed; vrchol b\u00fdv\u00e1 kolem 10. dne
- Odstran\u011bn\u00ed sleziny (splenektomie) \u2013 slezina norm\u00e1ln\u011b ni\u010d\u00ed star\u00e9 trombocyty; bez n\u00ed se hromad\u00ed v krvi; hodnoty mohou p\u0159esahovat 1 000 a p\u0159etrv\u00e1vaj\u00ed celo\u017eivotn\u011b
- Fyzick\u00e1 n\u00e1maha \u2013 p\u0159echodn\u00e9 m\u00edrn\u00e9 zv\u00fd\u0161en\u00ed
- L\u00e9ky \u2013 kortikosteroidy, vinkristin, epinefrin
Prim\u00e1rn\u00ed trombocyt\u00f3za \u2013 kdy je to onemocn\u011bn\u00ed kostn\u00ed d\u0159en\u011b
Prim\u00e1rn\u00ed (klon\u00e1ln\u00ed) trombocyt\u00f3za vznik\u00e1 p\u0159\u00edmou poruchou v kostn\u00ed d\u0159eni \u2013 desti\u010dky se tvo\u0159\u00ed nadm\u011brn\u011b bez reaktivn\u00edho podn\u011btu z t\u011bla. Je m\u00e9n\u011b \u010dast\u00e1 ne\u017e reaktivn\u00ed, ale z\u00e1va\u017en\u011bj\u0161\u00ed.
Esenci\u00e1ln\u00ed trombocyt\u00e9mie (ET)
Nej\u010dast\u011bj\u0161\u00ed prim\u00e1rn\u00ed p\u0159\u00ed\u010dina. Jde o myeloproliferativn\u00ed onemocn\u011bn\u00ed \u2013 klon\u00e1ln\u00ed porucha megakaryocyt\u016f v kostn\u00ed d\u0159eni. Charakteristiky:
- Trombocyty trvale nad 450\u2013600 \u00d7 10\u2079/l bez jin\u00e9 p\u0159\u00ed\u010diny
- U 60 % pacient\u016f nalezena mutace JAK2 V617F
- Zv\u00fd\u0161en\u00e9 riziko tromb\u00f3zy (infarkt, mrtvice, plicn\u00ed embolie) i krv\u00e1cen\u00ed (paradoxn\u011b)
- Diagn\u00f3za: biopsie kostn\u00ed d\u0159en\u011b + genetick\u00e9 testy
- L\u00e9\u010dba: aspirin, p\u0159i vysok\u00e9m riziku hydroxyurea nebo anagrelid
Dal\u0161\u00ed myeloproliferativn\u00ed onemocn\u011bn\u00ed
- Polycythaemia vera (PV) \u2013 zv\u00fd\u0161en\u00ed \u010derven\u00fdch krvinek i trombocyt\u016f; mutace JAK2
- Prim\u00e1rn\u00ed myelofibr\u00f3za \u2013 fibr\u00f3za kostn\u00ed d\u0159en\u011b; trombocyty mohou b\u00fdt zpo\u010d\u00e1tku zv\u00fd\u0161en\u00e9, pak klesaj\u00ed
- Chronick\u00e1 myeloidn\u00ed leuk\u00e9mie (CML) \u2013 zv\u00fd\u0161en\u00ed granulocyt\u016f i trombocyt\u016f
Jak rozli\u0161it reaktivn\u00ed od prim\u00e1rn\u00ed trombocyt\u00f3zy
| Znak | Reaktivn\u00ed | Prim\u00e1rn\u00ed (ET) |
|---|---|---|
| P\u0159\u00ed\u010dina | Infekce, z\u00e1n\u011bt, nedostatek Fe | Porucha kostn\u00ed d\u0159en\u011b |
| Hodnota trombocyt\u016f | Z\u0159\u00eddka nad 1 000 | \u010casto nad 1 000, trvale |
| CRP a z\u00e1n\u011btliv\u00e9 markery | Zv\u00fd\u0161en\u00e9 | Norm\u00e1ln\u00ed |
| Ferritin | M\u016f\u017ee b\u00fdt sn\u00ed\u017een\u00fd | Norm\u00e1ln\u00ed |
| Mutace JAK2 | Negativn\u00ed | Pozitivn\u00ed u 60 % |
| Pr\u016fb\u011bh | P\u0159echodn\u00fd, normalizuje se po l\u00e9\u010db\u011b p\u0159\u00ed\u010diny | Trval\u00fd, progresivn\u00ed |
| Riziko tromb\u00f3zy | M\u00edrn\u011b zv\u00fd\u0161en\u00e9 | V\u00fdrazn\u011b zv\u00fd\u0161en\u00e9 |
Kdy j\u00edt k l\u00e9ka\u0159i
| Situace | Doporu\u010den\u00ed |
|---|---|
| 400\u2013500, prob\u00edhaj\u00edc\u00ed infekce nebo z\u00e1n\u011bt | Kontroln\u00ed odb\u011br za 4\u20136 t\u00fddn\u016f po \u00fastupu infekce \u2013 pravd\u011bpodobn\u011b se normalizuje |
| 400\u2013600, n\u00edzk\u00fd ferritin | Doplnit \u017eelezo, kontroln\u00ed odb\u011br za 3 m\u011bs\u00edce |
| Nad 600 bez zjevn\u00e9 p\u0159\u00ed\u010diny | Hematologick\u00e1 konzultace \u2013 vylou\u010den\u00ed ET a jin\u00fdch myeloproliferativn\u00edch onemocn\u011bn\u00ed |
| Nad 1 000 | Neprodlen\u011b hematolog \u2013 nutn\u00e1 biopsie kostn\u00ed d\u0159en\u011b |
| Jak\u00e1koliv hodnota + bolest hlavy, rozmazan\u00e9 vid\u011bn\u00ed, brn\u011bn\u00ed rukou, bolest na hrudi | Okam\u017eit\u011b l\u00e9ka\u0159e \u2013 mo\u017en\u00e1 tromb\u00f3za |
Nej\u010dast\u011bj\u0161\u00ed ot\u00e1zky
Zp\u016fsobuj\u00ed zv\u00fd\u0161en\u00e9 trombocyty sr\u00e1\u017een\u00ed krve?
P\u0159i reaktivn\u00ed trombocyt\u00f3ze je riziko tromb\u00f3zy jen m\u00edrn\u011b zv\u00fd\u0161en\u00e9 \u2013 funkce desti\u010dek b\u00fdv\u00e1 norm\u00e1ln\u00ed. P\u0159i prim\u00e1rn\u00ed trombocyt\u00e9mii (ET) je riziko v\u00fdrazn\u011b vy\u0161\u0161\u00ed \u2013 desti\u010dky mohou b\u00fdt funk\u010dn\u011b abnorm\u00e1ln\u00ed a tendenci k agregaci maj\u00ed zv\u00fd\u0161enou. Proto pacienti s ET dost\u00e1vaj\u00ed preventivn\u011b aspirin.
Mohou zv\u00fd\u0161en\u00e9 trombocyty zp\u016fsobovat p\u0159\u00edznaky?
M\u00edrn\u00e1 reaktivn\u00ed trombocyt\u00f3za obvykle \u017e\u00e1dn\u00e9 p\u0159\u00edznaky nezp\u016fsobuje. P\u0159i vysok\u00fdch hodnot\u00e1ch (nad 1 000) nebo p\u0159i ET se mohou objevit: bolesti hlavy, z\u00e1vra\u0165, brn\u011bn\u00ed nebo p\u00e1len\u00ed prst\u016f (erytromelalgie), rozmazan\u00e9 vid\u011bn\u00ed, nebo naopak sklon ke krv\u00e1cen\u00ed z nosu a d\u00e1sn\u00ed. Tyto p\u0159\u00edznaky v\u017edy konzultujte s l\u00e9ka\u0159em.
Jak rychle se trombocyty normalizuj\u00ed po infekci?
P\u0159i reaktivn\u00ed trombocyt\u00f3ze zp\u016fsoben\u00e9 infekc\u00ed se hodnoty obvykle normalizuj\u00ed do 2\u20134 t\u00fddn\u016f po \u00fastupu infekce. Po operaci b\u00fdv\u00e1 vrchol kolem 10. dne a normalizace do 4\u20136 t\u00fddn\u016f.
Informace maj\u00ed eduka\u010dn\u00ed charakter a nenahrazuj\u00ed l\u00e9ka\u0159sk\u00e9 vy\u0161et\u0159en\u00ed. V\u00fdsledky krevn\u00edho obrazu v\u017edy konzultujte se sv\u00fdm l\u00e9ka\u0159em.
\u2192 Souvisej\u00edc\u00ed: Trombocyty norma | Ferritin | P\u0159ehled laboratorn\u00edch hodnot