Treatment of thrombocytopathies

General principles of treatment of acquired and hereditary thrombocytopathy

The diet of patients with thrombocytopathy should be vitaminized with the exception of vinegar-containing canned foods. Additionally, multivitamins, nettle broth and peanut nuts are prescribed.

Excludes drugs that cause violation of the properties of platelets: salicylates, curantyl, papaverine, euphyllin, indomethacin, brufen, carbenicillin, nitrofurans. The use of drugs that inhibit the metabolism of arachidonic acid and disrupt the function of platelets, as well as physiotherapeutic procedures (UFO, UHF) is limited .

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

General haemostatic therapy: bleeding appoints a 5% solution of aminocaproic acid in a daily dose of 200 mg / kg, which is injected / drip, the rest is taken internally. Later on, when the bleeding is reduced, the drug is taken orally. Aminocaproic acid stimulates the adhesion and aggregation properties of platelets and increases the resistance of the vascular wall. Similarly, 12.5% solution of dicinone (sodium etamzilate) is administered intravenously, 2-4 ml, and then inside 1-2 tablets 4 times a day. Dicycin reduces the inhibitory effect of prostacyclin on the aggregation of platelets. Instead of dicinone, a 0.025% solution of adroxone can be used intramuscularly for 1-2 ml. To stop bleeding, use intravenous fluids 10% calcium gluconate solution for 1-5 ml, depending on age.

Local haemostatic therapy: with a nosebleed, 3% hydrogen peroxide solution + a mixture of solutions of thrombin, adroxone and aminocaproic acid (1 amp thrombin + 50 ml of 5% aminocaproic acid + 2 ml 0.025% solution of adroxone) is instilled. The same solution is used to stop postoperative and uterine bleeding. When uterine bleeding to enhance the contractility of the uterus apply pregnin, and with confirmed hormonal disorders - estrogen preparations intramuscularly: folliculin (5000-10000 ED), synestrol (2 ml 0.1% solution).

Emergency care for nasal bleeding. The child is given a semi-sitting position, so that the blood is not swallowed and freely poured into the inserted tray, which is important for determining the amount of blood loss. On the back of the head put a bubble with ice, which reflex helps to stop bleeding. It is recommended to insert a hemostatic sponge, cotton wool or a tampon moistened with 3% hydrogen peroxide in the nasal passage, pressing it through the nose wing.

In the absence of effect, anterior tamponade of the nasal cavity is used: a gauze pad moistened with 5% e-aminocaproic acid or hydrogen peroxide. Consistently perform deepening of the nasal cavity. If inefficiency is produced, the posterior tamponade of the nose. After anesthesia, the bleeding area can be pricked with silver nitrate.

With continuous or repeated bleeding appoint preparations of general hemostatic effect - intravenous aminocaproic acid at a dose of 0.1-0.2 g / kg, intramuscularly 2.5% solution of adroxone 1-2 ml 2-4 times a day, 12.5 % solution of dicinone (etamzilate) 2-4 ml every 4-6 hours. In case of recurrent bleeding, in addition to treating the underlying disease, oily solutions are used intranasally to prevent atrophic rhinitis. Hemostasiological examination is necessary.

Forecast. With hereditary thrombocytopathy in cases of absence of intracranial hemorrhages for life, favorable, if adequate therapy is performed and the severe blood loss is eliminated on time. It should be noted that massive intracranial hemorrhages are characteristic only for very severe forms of thrombastenia, Willebrand's disease and Bernard-Soulier syndrome.

Dispensary 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, according to indications - more often.
• The volume of the examination: a blood test with counting the number of platelets - 1-2 times a month urine analysis - 2-3 times a year coagulogram and retraction of the blood clot - once a month coagulogram and retraction of the blood clot - 1 time in 3-6 months and at the appearance of hemorrhagic syndrome.
• The volume of rehabilitation: a full vitaminized (vitamins C and PP) diet, a regime with limited physical exertion, without insolation. Continuation of glucocorticosteroid therapy initiated in the hospital, the use of symptomatic and vasoconstrictive drugs: ascorutin, calcium preparations, aminocaproic acid of drugs that improve the functional properties of thrombocytes: etamzilate, riboxin, trental, ATP. Phytotherapy: chokeberry, wild rose, shepherd's bag, water pepper, nettle leaf for 10-15 days of each month. Exemption from the lessons of physical education and examinations. Sanitation of foci of chronic infection. Rehabilitation therapy courses for 3-4 weeks 1 time per 3 months and during intercurrent diseases. Withdrawal from registration and vaccination after 5 years of persistent clinical and laboratory remission.

Complete clinical and laboratory remission.

• Consultations: pediatrician and hematologist - once in 3-6 months ENT and dentist - once a year.
• Scope of the examination: blood count with platelet count - 1 time per 3 months urine test - once a year coagulogram and retraction of the blood clot - according to indications.
• The volume of rehabilitation: the diet is vitaminized, the regime is free by age, physical education in the preparatory group, from the 3rd year of complete remission - in the main group. Reception vasoconstrictive agents and phytopreparations. Improvement in local sanatoria.

Rehabilitation therapy courses lasting 3-4 weeks in the spring and autumn and in the period of intercurrent diseases.

Thrombocytopathy prophylaxis

Primary prophylaxis of the disease is not developed, secondary prevention of relapses includes: planned sanation of foci of infection prevention of contacts with patients with infectious diseases (especially acute respiratory viral infections) deworming individual solution of the question of carrying out preventive vaccinations, avoiding insolation, UFO and UHF physical education in the preparatory group, mandatory blood test after any disease.