Treatment of thrombocytopathies

General principles of treatment of acquired and hereditary thrombocytopathy

The diet of patients with thrombocytopathy should be fortified with vitamins, excluding vinegar-containing canned products. Additionally, multivitamins, nettle decoction and peanuts are prescribed.

Drugs that cause platelet dysfunction are excluded: salicylates, curantil, papaverine, euphyllin, indomethacin, brufen, carbenicillin, nitrofurans. The intake of drugs that inhibit arachidonic acid metabolism and impair platelet function, as well as physiotherapeutic procedures (UV irradiation, UHF) is limited.

Treatment of concomitant diseases and rehabilitation of chronic foci of infection are carried out.

General hemostatic therapy: in case of bleeding, a 5% solution of aminocaproic acid is prescribed at a daily dose of 200 mg/kg, which is administered intravenously by drip, the rest is taken orally. Later, when bleeding decreases, the drug is taken orally. Aminocaproic acid stimulates the adhesive-aggregation properties of platelets and increases the resistance of the vascular wall. Similarly, a 12.5% solution of dicynone (sodium etamsylate) is used intravenously at 2-4 ml, and then orally at 1-2 tablets 4 times a day. Dicynone reduces the inhibitory effect of prostacyclin on platelet aggregation. Instead of dicynone, a 0.025% solution of adroxone can be used intramuscularly at 1-2 ml. To stop bleeding, intravenous infusions of a 10% solution of calcium gluconate at 1-5 ml are used depending on age.

Local hemostatic therapy: for nosebleeds, instill a 3% hydrogen peroxide solution + a mixture of thrombin, adroxone and aminocaproic acid solutions (1 ampoule of thrombin + 50 ml of 5% aminocaproic acid + 2 ml of 0.025% adroxone solution). The same solution is used to stop postoperative and uterine bleeding. For uterine bleeding, pregnin is used to enhance the contractility of the uterus, and in case of confirmed hormonal disorders, estrogenic drugs are administered intramuscularly: folliculin (5000-10000 U), sinestrol (2 ml of 0.1% solution).

First aid for nosebleeds. The child is placed in a semi-sitting position so that the blood is not swallowed and flows freely into a tray, which is important for determining the volume of blood loss. An ice pack is placed on the back of the head, which reflexively helps stop the bleeding. It is recommended to insert a hemostatic sponge, cotton wool or tampon soaked in 3% hydrogen peroxide into the nasal passage, pressing it through the wing of the nose.

If there is no effect, anterior tamponade of the nasal cavity is used: a gauze swab soaked in 5% e-aminocaproic acid or hydrogen peroxide is used to consistently make indentations in the nasal cavity. If ineffective, posterior tamponade of the nose is used. After anesthesia, the bleeding area can be cauterized with silver nitrate.

In case of persistent or repeated bleeding, drugs of general hemostatic action are prescribed - intravenous administration of aminocaproic acid at a dose of 0.1-0.2 g/kg, intramuscular 2.5% solution of adroxone 1-2 ml 2-4 times a day, 12.5% solution of dicinone (etamsylate) 2-4 ml every 4-6 hours. In case of recurrent bleeding, in addition to therapy for the underlying disease, oil solutions are used intranasally to prevent atrophic rhinitis. Hemostasis examination is necessary.

Prognosis. In hereditary thrombocytopathy, in cases of absence of intracranial hemorrhages, life is favorable if adequate therapy is carried out and significant blood loss is eliminated in time. It should be noted that massive intracranial hemorrhages are characteristic only of very severe forms of thrombasthenia, von Willebrand disease and Bernard-Soulier syndrome.

Outpatient observation of patients with thrombocytopathy

Incomplete clinical and laboratory remission.

• Consultations: pediatrician - once a month, ENT and ophthalmologist - once a year, dentist - 2 times a year, hematologist - 1-2 times a month, more often if indicated.
• Scope of examination: blood test with platelet count - 1-2 times a month urine test - 2-3 times a year coagulogram and blood clot retraction - 1 time per month coagulogram and blood clot retraction - 1 time in 3-6 months and when hemorrhagic syndrome appears.
• Rehabilitation volume: a complete vitamin-rich (vitamins C and PP) diet, a regimen with limited physical activity, without insolation. Continuation of glucocorticosteroid therapy started in the hospital, intake of symptomatic and vascular strengthening drugs: askorutin, calcium preparations, aminocaproic acid drugs that improve the functional properties of platelets: etamsylate, riboxin, trental, ATP. Phytotherapy: chokeberry, rose hips, shepherd's purse, water pepper, nettle leaf for 10-15 days each month. Exemption from physical education classes and exams. Sanitation of foci of chronic infection. Courses of rehabilitation therapy for 3-4 weeks once every 3 months and during intercurrent diseases. Deregistration and vaccination after 5 years of stable clinical and laboratory remission.

Complete clinical and laboratory remission.

• Consultations: pediatrician and hematologist - once every 3-6 months; ENT and dentist - once a year.
• Scope of examination: blood test with platelet count - once every 3 months, urine test - once a year, coagulogram and blood clot retraction - as indicated.
• Rehabilitation volume: vitamin-rich diet, free regimen according to age, physical education classes in the preparatory group, from the 3rd year of complete remission - in the main group. Taking vascular strengthening agents and herbal preparations. Health improvement in local sanatoriums.

Rehabilitation therapy courses lasting 3-4 weeks in spring and autumn and during periods of intercurrent illnesses.

Prevention of thrombocytopathy

Primary prevention of the disease has not been developed, secondary prevention of relapses includes: planned sanitation of foci of infection prevention of contacts with patients with infectious diseases (especially acute respiratory viral infections) deworming individual decision on the issue of preventive vaccinations exclusion of insolation, ultraviolet irradiation and UHF physical education classes in the preparatory group mandatory blood testing after any illness.