There is probably not a single person on Earth who has not been scratched by something at least once in his life. At first, the damaged skin bleeds, and after a while the bleeding stops. The damaged area becomes inflamed, swells, and then the wound heals, and not a trace remains of the scratch. This is what happens to most people.

In some people, blood does not clot well, which can lead to various undesirable consequences. What is especially dangerous is not scratches and cuts with external blood loss, but internal bleeding that cannot be cauterized or stopped by applying a tampon. Why is this possible?

The reason for this sad phenomenon is that or adult in the blood.

What are platelets, and what to do if the platelet count leaves much to be desired?

This is what platelets (blood platelets) look like under a microscope

Functions

Platelets are blood cells generated by the bone marrow, the importance of which is difficult to overestimate. Platelets stay in the blood from a week to a week and a half, after which they die in the spleen, liver and lungs.

Platelets are small in size, their diameter is 2-4 micrometers. They have either an oval or round shape. They do not have a nucleus, but platelets contain many granules (about 200) of different types. What functions does an adult, fully mature platelet perform in the body?

1. The most important function is that platelets stop bleeding.
2. They take part in fibrinolysis, which dissolves a blood clot.
3. These cells can influence the permeability of capillaries and transport essential nutrients to them.
4. Platelets, like white blood cells, are able to protect the body from bacteria.

Norm

The number of platelets in the blood is determined by a laboratory test. For this purpose, clinical blood tests are performed. The test results are studied by the attending physician and communicated to patients.

The normal range is considered to be from 200 thousand to 400 thousand units in one cubic millimeter of blood in an adult.

Doctors distinguish three degrees of platelet reduction depending on how much platelets are below normal.

1. A mild form is present with the following indicators: in the patient’s blood, platelets are in the range of 50-150 thousand units per microliter.
2. At the second stage of the disease (moderate), the platelet level ranges from 20 to 50 thousand units.
3. The third degree is characterized by a further decrease in cells. Very low platelet counts are recorded at this stage. Their number is below the critical threshold of 20 thousand.

Low platelets in the blood can be a primary blood disorder or mean that there are pathologies in the body that cause a decrease in platelets.

Symptoms

When the content of these cells in the blood decreases, symptoms characteristic of each stage are observed.

1. At the first stage, a low platelet count does not give clear signs of the disease.
2. In the second degree, low platelet levels in the blood show clear symptoms. Bleeding from the nose and hemorrhages in the oral mucosa occur, and the gums bleed. Indicators of the disease are bruises, although the nature of the injury does not imply such severe subcutaneous hemorrhage.
3. At the third stage of the disease, when platelets have dropped to a critical level, symptoms appear that sound the alarm - profuse hemorrhages affect the skin and mucous membranes, nosebleeds often and heavily.

The third stage of the disease is dangerous because adults and children have no complaints of feeling unwell, although the degree of platelet reduction has reached critical levels, and the consequences can be severe, including cerebral hemorrhage.

What diseases reduce platelet levels in the blood?

Group 1

This group includes diseases of a genetic nature.

1. Thrombocytopenia is caused by TAP syndrome, in which the growth and maturation of megakaryocytes is damaged, resulting in a lower than normal platelet count.
2. Megakaryocytes suffer from a reduced ability to grow and develop in congenital amegakaryocytic thrombocytopenia. The result is identical - blood platelets fall in the blood.
3. The number of cells is reduced with a simultaneous increase in their size to gigantic sizes with the May-Hegglin anomaly.
4. The number of blood platelets is reduced in Bernard-Soulier syndrome, when very large cells are formed, but they lack the ability to adhere to the inner walls of damaged vessels and communicate with each other.
5. Thrombocytopenia cannot be avoided with Wiskott-Aldrich syndrome, when platelets are pathologically small. Due to their small size, they have defects in their structure, therefore they are functionally incapacitated and live for several hours.

Group 2

This group includes diseases in which the bone marrow does not produce the required number of blood cells. With these diseases, a sharp, critical decrease in platelets is often observed.

1. Acute leukemia causes uncontrolled division of stem cells with the formation of their clones, which cannot perform the functions assigned by nature. Reproduction of clones results in a reduced number of normal hematopoietic cells, and due to their deficiency, a lack of the required number of blood cells is observed in the blood test.
2. A similar process with consequences in the form of a reduced number of blood cells of all types is observed with aplastic anemia.
3. Myelodysplastic syndrome results in an abnormal increase in the number of immature hematopoietic cells, which form equally dysfunctional blood cells. The result is reduced levels of platelets, leukocytes and red blood cells.
4. With myelofibrosis, there is an increased proliferation of fibrous tissue, which gradually fills the entire bone marrow. In parallel, there is a process of reducing the production of blood cells.
5. The cause of the deficiency may be cancer metastases. Because of them, the production of hematopoietic cells produced in the bone marrow decreases.

Group 3

This group includes diseases in which the number of produced blood platelets decreases due to the fact that the body intensively destroys them.

1. A low number of blood platelets is observed in autoimmune thrombocytopenia.
2. Another cause of low platelets is Evans-Fisher syndrome, when the body begins to produce antibodies to normal blood cells, as a result of which they die and there is a shortage of them in the blood.
3. A deficiency of these blood cells is sometimes observed in newborns. A decrease in the number of blood platelets is caused by the presence on the surface of the child’s blood platelets of antigens that are not on the mother’s platelets.

Group 4

This group includes pathologies of consumption and redistribution of blood platelets, causing their deficiency.

• The first triggers the mechanism of platelet activation directly in the bloodstream, when there is no damage to the internal surfaces. The bone marrow responds to the increased consumption of blood platelets by increasing their production, which is fraught with thrombocytosis. The desire of the bone marrow to produce more and more platelets depletes it, reproductive capacity begins to decline, and a drop in the number of platelets becomes inevitable.

• The second pathology occurs when up to 90% of platelets are deposited in the spleen due to increased size (splenomegaly), which means their content in the blood is reduced.

Group 5

In these cases, the reason for the low levels of platelet content should be sought in the negative impact of external factors.

Treatment boils down to the fact that, based on the research carried out, the causes of the lack of normal platelet counts are identified and eliminated.

1. If the disease is at the first stage, although their content in the tests is reduced, it is not necessary to treat the patient with medications.
2. In the second stage, with a serious decrease in platelets, drug treatment is necessary. The list of medications varies depending on the pathology that has reduced the number of blood platelets. Most often, treatment is carried out with the following drugs:

• immunoglobulin;
• prednisolone;
• vincristine;
• ethamsylate;
• eltrombopag;
• vitamin B12.

1. If the level has dropped to 20 thousand per microliter and threatens to fall further, then a patient with such indicators is subject to mandatory hospitalization. The slightest shock is enough for the condition to become critical.

If the level of blood platelets drops below the acceptable level, and drug therapy is ineffective, blood transfusions and surgery are practiced.

Blood transfusion can cause serious complications and does not always lead to positive results, although it is necessary in some cases.

During surgery, an operation is performed to remove the spleen, since this organ is the main source of antibodies that destroy blood platelets. In most cases, platelets will return to normal after surgery.

In the absence of alternatives, when the low level is caused by severe damage to the bone marrow, a bone marrow transplant is used.

Normally, the number of cells responsible for blood clotting (platelets) should be in the range of 150,000–400,000 per milliliter. The platelet count is not always within these limits. Depending on various factors, the analysis may show low platelets or, conversely, an excess of them. In medicine, such phenomena are called thrombocytopenia and thrombocytosis, respectively. Conditions of the body in which platelets are low will be discussed later in this article.

Low platelet count: causes

A very low number of platelets in the blood can be caused by various factors.

Infectious factors:

1. Herpes. Symptoms of this disease appear on the lips, the area around the nose, and on the surface of the genitals;
2. Hepatitis. All types of the disease affect the liver, increase its size and are accompanied by inflammation of this human organ;
3. Cold. All diseases such as ARVI, acute respiratory infections, tonsillitis, laryngitis, influenza and other diseases caused by infection, viruses or bacteria entering the human body;
4. Mononucleosis. Can be transmitted through saliva and other human bodily fluids, caused by a virus;
5. HIV and AIDS. A disease characterized by viral damage to the human immune system. Treatment of immunodeficiency is ineffective;
6. Lupus and other autoimmune diseases. The body begins to fight its cells, mistaking them for pathogens;
7. Gaucher's disease. A congenital pathology that affects the normal functioning of various human systems and organs: lungs, spleen, kidneys, liver and brain. Causes a decrease in glucocerebrosidase activity, symptoms may manifest as bone deformation;
8. Blood cancer or oncology of another organ;
9. Medicines (Heparin, Aspirin) that thin the blood;
10. Blood thinning products (ginger, lemon, cherries, garlic, onions and others).

Non-infectious factors:

Sometimes platelets are low in a woman’s blood during pregnancy, with vitamin deficiency, enlarged spleen, or intoxication of the human body with alcohol or heavy metals. The causes may be different, so treatment should be prescribed only after identifying the origin of the disease.

Signs that platelets are low

Very clear signs and symptoms do not accompany thrombocytopenia. You can suspect a condition in which platelets are low based on a number of manifestations:

• Heavy menstruation. Very heavy monthly bleeding may indicate several abnormalities, one of which is a reduced platelet count in the blood. The gynecologist will find out the causes of this condition and prescribe treatment;
• Hematomas. Bruises appear with very little pressure and sometimes it is impossible to remember what caused them to appear on the body;
• Frequent nosebleeds;
• Severe bleeding when soft tissue is damaged. Sometimes a simple cut can pose a threat to a person's life, in a condition where the platelets in the blood are below normal.

All signs of the disease manifest themselves in the form of violations of bleeding control. Platelets, if there are few of them in the blood, cease to perform their function of “clogging” vascular damage.

Long-term decline and consequences

If the number of platelets in the body constantly decreases, then life-threatening conditions may occur:

• Bleeding that cannot be stopped;
• Stroke – hemorrhage in the vessels of the brain.

A low level of platelets in the blood (below 30,000) can cause a stroke and, as a result, death of a person, or leave him disabled for life.

Diagnosis and risk groups

Platelets are important cells in our body. If you notice signs in yourself that indicate a decrease in such cells, then you need to take and interpret a blood test in a regular clinic. If the decoding result shows a low platelet count, then measures must be taken to normalize it.

All people are at risk for low platelet counts. Why? Because no one is immune from contracting an infection, be it a respiratory or any other disease. Is it possible to reduce the likelihood of such a disease? Yes it is possible. To do this, it is necessary to strengthen the immune system as a whole. You can resort to hardening procedures, moderate physical activity, proper balanced nutrition and other methods.

Treatment

Treatment of platelet deficiency is not carried out with medications due to the lack of such. And yet you can improve the situation by increasing their number.

Power optimization

The diet should contain foods rich in vitamins and microelements. It is necessary to include fruits and vegetables containing retinol (vitamin A) and ascorbic acid (vitamin C): spinach, rose hips, fish oil, bell peppers, carrots, potatoes, parsley, almonds.

Foods containing iron will help increase platelet levels: beets, meat, buckwheat, apples. You need to exclude pickles, pickled foods, smoked foods, and hot seasonings.

Healthy lifestyle

If platelets are low, then it is necessary to completely eliminate the consumption of alcohol-containing foods and drinks and stop smoking. If you continue to do this, the level of these cells will decrease even more and you will be at risk of having a stroke.

Medicines that strengthen the immune system

To further stimulate the activation of the immune system, you can take echinacea tincture (Immunal or an analogue), vitamin complexes (compositions containing microelements are good). Panavir is used for the prevention and treatment of herpes. It is best to discuss treatment with other means with your doctor.

Traditional recipes for low platelet levels

Nettle
Treatment is carried out with juice and infusion based on nettle.
Tinctures containing alcohol or vodka cannot be used.

Recipe 1. To prepare the composition, you need to take a teaspoon of nettle juice and mix it with 50 ml of water or milk. Consume before every meal.

Recipe 2. Take 10 g of dry nettle leaves, add a glass of boiling water. Cook the mixture for 3 minutes over low heat. After this, pour the composition into the thermos and leave for 30 minutes. Drink half a glass before each meal.

Sesame oil

Treatment with sesame oil must be carried out for a long time (you must drink at least 2 liters during the entire course). Take a large spoonful of oil 30 minutes before meals.

Rosehip, nettle, chamomile
Mix these ingredients in a ratio of 3:2:1, grind with a blender or coffee grinder. Pour the resulting mixture with boiling water (1 liter) and leave in a thermos for an hour. After 60 minutes, strain, add the juice of half a lemon and a tablespoon of flower honey. Treatment is carried out during the day 3 times before meals, 30 minutes per glass.

If a blood test reveals a decrease in platelet count, this is an alarming factor. Having determined the cause: a disease that caused a decrease in the number of platelets or another factor, appropriate treatment can be started. To do this, you need to consult a doctor. Only a specialist with a medical education can prescribe competent treatment.

Platelets are small, flattened blood cells that travel through the bloodstream and play an important role in healing, blood clot formation and other vital processes. People suffering from thrombocytopenia have a low platelet count, which leads to complications ranging from severe to life-threatening. Treatment for this condition may include diet changes, medications, surgery, or transfusions of blood and its components. Never ignore your doctor's opinion when making treatment decisions. Remember - nothing can replace seeing a specialist.

Attention: The information in this article is for informational purposes only. Before using any methods, consult your doctor.

Steps

Part 1

Visit your doctor. The first step to diagnosing and treating any health problem (including thrombocytopenia) should be to see your doctor. In addition to accurately diagnosing your condition, a specialist can also help you decide which treatment plan will be most effective and convenient for your situation. If your doctor thinks your platelet count is low, he or she will likely order blood tests and perform a thorough examination to determine your actual platelet count.

• Even if you sure If you have a low platelet count, we strongly recommend that you seek a professional opinion from a specialist before undergoing treatment. Some signs of thrombocytopenia are not unique to this disease. Moreover, sometimes a low platelet level does not appear outwardly at all.

1. Look for symptoms of a low platelet count. The normal amount is between 150,000 and 400,000 units per microliter of blood. Levels below these parameters do not necessarily lead to visible symptoms. However, even patients who have no visible symptoms may respond to treatment by increasing the number of platelets produced. Although in many cases thrombocytopenia is accompanied by a different set of symptoms. Because platelets are involved in the formation of blood clots, many symptoms of low platelet counts are caused by the body's inability to control bleeding. The following are the most common symptoms of thrombocytopenia:

   • prolonged bleeding after minor cuts, scratches, surgeries, etc.;
   • nosebleeds;
   • blood in the mouth or gums (especially after brushing your teeth);
   • especially heavy menstrual bleeding;
   • blood in urine or stool;
   • unexplained bruising or small red spots on the skin called petechiae.

2. Find out the cause of your low platelet count. Thrombocytopenia has no specific cause. This can be caused by many internal or external factors. Or even be the result of a more serious medical condition. Because of this, it is especially important to investigate a case of thrombocytopenia with a doctor to determine the cause. The following are the most common causes of thrombocytopenia:

   • hereditary (genetic) disease;
   • diseases (for example, leukemia, etc.) or bone marrow dysfunction;
   • enlarged or poorly functioning spleen;
   • side effects of medications or treatments you are currently undergoing (for example, radiation, etc.);
   • autoimmune diseases (lupus, arthritis, AIDS, idiopathic thrombocytopenic purpura, etc.);
   • bacterial infection in the blood;
   • pregnancy and childbirth (although in these cases thrombocytopenia is not pronounced);
   • platelet thrombocytopenic purpura is a rare disease in which dead platelets begin to form numerous clots throughout the body.

   Part 2

   Drug treatment of thrombocytopenia

   1. Talk to your doctor about the medications you are taking. Because thrombocytopenia has many possible causes, the treatment your doctor prescribes for you may vary depending on what is causing your low platelet count. Sometimes the treatment plan is quite simple. If the specialist concludes that thrombocytopenia is caused by a side effect of the drugs you are taking, you will simply need to stop taking the drug or change it to another.

      • Keep in mind that if you are taking a strong anticoagulant such as heparin, there is a chance that your platelet levels will not increase after you stop taking the medication. You may need to take additional medications to help you recover.

   2. Increase your platelet levels with medications. Your doctor may prescribe certain medications that increase platelet production to treat thrombocytopenia. Similar medications, including eltrombopag and romiplostim, come in various forms and can be taken as tablets or injections. In some cases, they are used in conjunction with other thrombocytopenia treatment options - it all depends on the individual case.

      Get treatment with steroids. Steroids can reduce the activity of the body's immune system. Therefore, they are often used to treat thrombocytopenia caused by autoimmune diseases, when the body's own immune system mistakenly attacks the body rather than foreign proteins. Because steroids weaken the immune system, they also weaken the activity of the autoimmune factor that causes thrombocytopenia. However, a weakened immune system can increase the risk of infectious diseases, so additional treatment may be needed to reduce the likelihood of further complications.

      Try plasma transfusion or plasmapheresis. In rare cases of blood disorders associated with thrombocytopenia (for example, platelet thrombocytopenic purpura or hemolytic uremic syndrome (HUS)), the doctor may prescribe treatment that involves the use of the patient's blood plasma. Plasma is a part of the blood that contains, among other things, autoantibodies, the deficiency of which leads to disturbances in the functioning of the immune system. Because of this, plasma treatment or replacement may be effective in treating both blood disorders and autoimmune diseases. Plasma transfusion and plasmapheresis are similar but differ in the procedure used to recover the plasma.

      Consider spleen removal. Cases of thrombocytopenia that are particularly resistant to treatment sometimes require an operation called a splenectomy, where the doctor removes the spleen. Although the function of the spleen is not 100% clear, scientists have proven that it is involved in filtering the blood by removing old red blood cells and platelets from the bloodstream. In some cases, the spleen grows and filters out more platelets than necessary, leading to thrombocytopenia. Splenectomy may help in this situation. In any case, doctors usually try to use more gentle methods of treatment from the beginning, since there is no way back after removing the spleen.

      Give a platelet transfusion. If you have fewer than 50,000 platelets per microliter of blood and you are suffering from severe bleeding and blood loss, your doctor may recommend a platelet or blood transfusion to reduce the bleeding. Another option is if you have less than 50,000 platelets per microliter of blood and are not bleeding heavily, but are planning to have surgery. The doctor may also recommend a transfusion. In either case, the specialist installs an intravenous drip and healthy blood or platelets go directly into the bloodstream.

      Don't do anything. Not every case of thrombocytopenia requires treatment. For example, if your platelet level is low due to pregnancy, you may want to wait until after your baby is born to see if it has increased afterward. In moderate cases of thrombocytopenia, a person may not have significant symptoms or severe bleeding. When the likelihood that a condition will improve in the near future without intervention is high, or when there are no major changes in life in the foreseeable future, the doctor may recommend a very gentle treatment plan (or none at all).

   Part 3

   Treatment of thrombocytopenia with lifestyle changes

   Add vitamin B12 and folic acid to your diet. These two vitamins are essential for the body's normal production of many blood cells, including platelets. Since the body is not able to store these nutrients in large quantities, it is very important to take them regularly. To increase the amount of B12 and folic acid in your diet, take a dietary supplement that contains them or eat more foods high in them.

   • Foods such as spinach, citrus fruits, kiwi and legumes are high in folic acid, while egg whites, milk, cheese, liver and lamb are high in vitamin B12.

   1. Reduce the amount or completely avoid alcohol. Alcohol interferes with the normal reproduction and functioning of platelets. The immediate effect of alcohol intake (for non-abusers) is a decrease in platelet levels within 10-20 minutes after consumption.

It is not uncommon for platelets to be low in an adult. This condition is called thrombocytopenia. Often, a decrease in platelet levels is recorded in pregnant women, and even in children. Moreover, a decrease in platelets in children is quite dangerous and in some cases ends in death. This is important to know.

A decrease in the concentration of blood platelets can lead to unpleasant consequences. First of all, these are all kinds of hemorrhages (Werlhof's disease). Particularly dangerous are internal hemorrhages, which can be visually invisible, but the consequences can be disastrous.

Attention! Statistics show that untimely treatment of thrombocytopenia, for example, with the use of immunoglobulin, can lead to the development of oncology.

Many diseases affecting the circulatory system are provoked by thrombocytopenia. This is the name for a condition in which the level of platelets decreases. The result is anemia, hemophilia, and internal bleeding.

Normally, in adults it is in the range of 150-400 grams per liter of blood (in women – 150-380 g/l, and in men – 180-320). If tests show that the platelet count has dropped below 150 g/l, then thrombocytopenia is diagnosed. In this case, the blood loses its ability to clot and form a platelet plug, which leads to frequent bleeding and problems stopping it. The more platelets are reduced, the stronger the signs of pathology appear.

Diseases in which a decrease in platelet levels is recorded are accompanied by the following symptoms:

• problems stopping even minor bleeding;
• bleeding gums;
• periodic discharge of blood from the nose;
• hemorrhages in the gastrointestinal tract;
• pinpoint subcutaneous hemorrhages;
• hematuria – discharge of blood into the bladder, causing the urine to turn red;
• spontaneous formation of bruises.

In women, the menstrual cycle lengthens, and emissions become more abundant.

To confirm or rule out thrombocytopenia, the patient is referred for a blood test.

Platelets are low in a child

Very often, platelet levels drop below normal in children (newborns are no exception). According to statistics, such a pathology occurs in 75% of babies born with extremely low weight.

The disease is also detected in 35% of infants undergoing intensive care treatment.

There are many reasons that cause low platelet levels in children:

• birth of a child premature or post-term;
• incompatibility of blood groups of mother and baby;
• allergic reactions;
• anemia;
• infections or immunodeficiency diseases;
• hemoblastoses are tumors that affect blood cells;
• long-term use of medications.

Important! If platelets are significantly reduced in a child, then death occurs in 15% of cases. Therefore, you should not ignore the problem; it is better to contact a hematologist immediately.

It is necessary to consult with a specialist if parents notice that the baby develops bruises from the slightest touch, and a minor cut or ordinary injection leads to prolonged bleeding. This situation occurs due to the fact that with a low level of platelets, the blood clots poorly.

Read also on the topic

What is PLT in blood test. Norms and reasons for deviation

To detect thrombocytopenia, it is enough to do a general blood test. If the diagnosis is confirmed, the doctor will select the optimal medications and recommend a balanced diet, including vegetables, fruits, veal, rabbit meat, liver, and fatty fish.

In the secondary form, it is enough to eliminate the cause of the problem in order to cure the resulting disease.

If the primary form is detected, treatment will include:

• donor milk;
• immunoglobulin injections;
• taking ascorbic acid, rutin and prednisolone;
• platelet transfusion ( thrombocytopheresis ).

Platelets are low in an adult, what does this mean?

• congenital hemophilia;
• increased production of antibodies caused by infection entering the body;
  anemia - people with pale skin need to be wary, especially if the slightest blows cause bruises;
• leukemia;
• asphyxia – very often thrombocytopenia develops in people suffering from bronchial asthma;
• disseminated intravascular coagulation syndrome (DIC syndrome);
• viral and autoimmune diseases of various origins;
• severe injuries leading to significant blood loss;
• surgical intervention;
• hemodialysis - blood purification using a special device;
• professional activity in hazardous conditions;
• uncontrolled use of antibiotics, corticosteroids, cytostatics, diuretics, painkillers;
• thyrotoxicosis;
• abuse of alcoholic beverages, which dilate blood vessels, resulting in increased blood pressure.

In women, the cause of a situation where platelets are low can be menstruation and pregnancy.

For reference. If the platelet count has not decreased very much, then you can return it to normal at home.

If platelets are low in an adult, it is recommended to follow these rules:

• If possible, get an office position;
• reduce working hours (up to a maximum of 8 hours);
• sleep at least 8 hours;
• give up dangerous sports;
• do aerobics and other types of cardio exercises;
• increase the consumption of vegetables, herbs, berries, fruits, eggs, flaxseed oil, salmon and tuna meat, vitamin C and glucose;
• give up refined sugar;
• exclude cold drinks;
• Drink coffee and mulled wine periodically (but don’t get too carried away).

If platelets are significantly lower than normal (to a level of 20-50 g/l of blood), then outpatient treatment will be required. If the level drops below 20 g/l, then hospitalization is necessary.

Before prescribing treatment, the doctor finds out why the concentration of blood platelets has dropped below normal. Only by eliminating the cause of the pathology can you get rid of the problem.

Usually, if a decrease in platelets is detected, the doctor prescribes:

• intravenous administration of immunoglobulin;
• taking glucocorticosteroids;
• use of anti-Rhesus serum;
• platelet transfusion.

Platelets are low during pregnancy

• infectious diseases of the upper respiratory tract - vitamins and medications can neutralize the infection and strengthen the mother’s immunity;
• anemia;
• DIC syndrome;
• excessive use of medications (antibiotics, cytostatics, corticosteroids, analgesics, diuretics;
• deficiency of folic acid in the body of a pregnant woman;
• poor nutrition;
• hemodialysis;
• hormonal disbalance;
• stressful state;
• negligence of obstetricians who do not maintain sterility during childbirth.