Platelets need to be stable before surgery
The platelet level is the main basis to judge the severity of chronic idiopathic thrombocytopenic purpura. According to the experts, the platelets of normal people are above 100,000. In general, chronic idiopathic thrombocytopenic purpura patients should at least control the platelet above 30,000 to be relatively safe.
”Therefore, the biggest clinical concern for these thrombocytopenic patients is blindness or death due to visceral bleeding. Some female patients who become pregnant while their condition is not yet under control experience massive bleeding from the birth canal during delivery, which can be life-threatening in severe cases.” Professor Yang advises that patients who need surgery, tooth extraction and childbirth, which can cause heavy bleeding, must first be treated effectively to bring their platelets back up to 70,000 or more to be safe. Especially for women who have or have had this disease, they must be tested regularly at obstetrics and gynecology and hematology departments throughout their pregnancy to avoid anemia and hemorrhage in the birth canal as much as possible to ensure the safety of mother and baby.
Features.
Blood spots appear on the skin Significant reduction in platelets
”Idiopathic thrombocytopenic purpura, also known as immune thrombocytopenic purpura, is a common bleeding disorder characterized by a decrease in platelets, while the appearance of purple spots on the skin mucosa and even internal bleeding are its main symptoms.” Professor Yang Hongchong, director of the Department of Hematology at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, pointed out that at first, generally patients only have small red spots on the skin like pinpoints, which do not fade even when pressed by hand, and large ones even fuse into plaques. These spots can occur suddenly and spread all over the body, but more often on the limbs, and often recur, and in serious cases, internal bleeding can occur and endanger life.
According to the patient’s age of onset, clinical manifestations, duration of thrombocytopenia and treatment effect, idiopathic thrombocytopenic purpura can be divided into two types, acute and chronic, as follows.
Acute: It is common in children, often develops in winter and spring, and there is often a history of respiratory tract infection or other viral infection 1 to 3 weeks before the onset. The onset of the disease is rapid, there may be fever, chills, sudden onset of extensive and severe skin bleeding, mainly in the lower extremities, in the form of dots, purpura or petechiae; mucosal bleeding is mostly seen in the nasal cavity, gums, and in severe cases, visceral bleeding.
Chronic: It occurs mostly between 20 and 50 years old, more common in women, with an incidence twice as high as that of men, with insidious onset and mild symptoms. Repeated bleeding from the skin and mucous membranes, partly with excessive menstruation as the main manifestation, subcutaneous bleeding is mild; the duration of the disease is more than half a year, without systematic treatment, can be recurrent, delayed for decades. In a few cases, anemia is caused by severe bleeding, and in severe cases, internal bleeding may occur.
Treatment:Western medicine vs. Chinese medicine
Western medicine.
Hormone + splenectomy
Professor Yang said that the cause of the disease is not fully understood, glucocorticoids are currently the first choice of Western medicine for the treatment of primary thrombocytopenic purpura, but long-term application of large amounts or sudden discontinuation of the drug will produce many serious adverse reactions. Many patients taking hormone for a period of time will cause increased appetite, body fat, skin acne, some may even induce and aggravate infection, and may also cause gastrointestinal ulcers and bleeding, hypertension, diabetes, osteoporosis, femoral head necrosis and other side effects, so we must strictly regulate the use of drugs under the guidance and supervision of doctors.
If platelets continue to decrease after six months of hormone therapy and bleeding symptoms recur, removal of the spleen should be considered. Splenectomy treatment is still considered to be one of the effective methods in Western medicine for treating this disease. Because the spleen is the main organ that produces platelet antibodies and is the main site of platelet destruction, splenectomy can reduce antibody production and platelet destruction.
However, some studies have found that in about 50% of patients, platelets are destroyed elsewhere, such as in the liver or parasplenium, when platelets do not increase significantly even if the spleen is removed. Some studies have shown that splenectomy results in partial improvement in only 1/3 to 1/2 of patients, and nearly 1/5 of patients relapse after splenectomy. Therefore, treatment with immunosuppressive drugs has also been tried, but the results are not satisfactory and there is a threat of affecting fertility or even causing cancer.
TCM.
Clearing heat and cooling blood + benefiting Qi to stop bleeding
From the perspective of TCM, chronic idiopathic thrombocytopenic purpura is caused by dysfunction of the heart, spleen, liver, kidney and other internal organs, resulting in blood heat delusion, or internal heat of Yin deficiency, or Qi deficiency of the spleen and kidney, often with wind, dampness, phlegm, stasis and other evil. If the patient’s platelets are above 30,000 to 40,000 and there is no obvious bleeding, they can be treated by pure Chinese medicine, which is characterized by small side effects, less recurrence, and can prevent or reduce side effects such as skin acne, osteoporosis and femoral head necrosis; however, when the platelets are below 20,000, Chinese medicine with hormone therapy should be considered safer and more effective.
According to Prof. Yang, TCM treatment for this disease is roughly divided into blood heat delusion, yin deficiency and fire, qi does not take blood and other evidence types, and the treatment principle is to clear heat and cool blood, benefit qi and stop bleeding. And different patients need to find the pulse of experts to consult in order to prescribe the right medicine, to achieve the best results.
Daily recuperation is important
Professor Yang said, whether you choose Chinese medicine or Western medicine treatment, in addition to the use of drugs, patients in daily life should pay more attention to recuperation –
1, pay attention to warmth, to prevent cold caused by infectious diseases; throat and other parts of the infection, should be promptly to the specialist follow-up, as soon as possible to control the infection, to avoid the risk of aggravation of the disease.
2, the diet requires high protein, high vitamin, easy to digest, avoid spicy, greasy, fried, coarse and hard and other stimulating things. Those with positive fecal occult blood should eat a semi-liquid diet, and those with obvious bleeding in the digestive tract should be given a liquid diet. Those who have anemia should eat more iron-rich animal blood, liver, seaweed, kelp and dairy eggs and other tonic foods, but not too warm tonic. Daily dietary therapy can be used 15-50 grams of peanuts, 5-10 red dates decoction with water. Those without diabetes can also add brown sugar in appropriate amounts. Excessive bleeding, in addition to the use of drugs to stop bleeding, you can take 500 to 1000 grams of fresh lotus root, wash, mash, juice 1 to 2 bowls of tea drink, has a strong heat, cool blood, hemostatic effect.
3, pay attention to the combination of work and rest, avoid overwork; appropriate exercise, such as walking or tai chi is appropriate, but to avoid trauma, to prevent bleeding or aggravate bleeding.
4, patients with platelets less than 30,000 to 50,000 should avoid surgery, intramuscular injection, acupuncture, massage and massage, gua sha, cupping, hot compress and other treatments.