1, Basic information of idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura is caused by immune abnormalities and the presence of anti-platelet antibodies in the blood circulation, which causes excessive platelet destruction and thus purpura. It is characterized by impaired maturation of bone marrow megakaryocytes and a significant decrease in peripheral platelets. According to the pathogenesis, predisposing factors, disease and course, ITP can be divided into two types: acute type and chronic type.
2.The principles and methods of health care for idiopathic thrombocytopenic purpura, Department of Hematology, Guangdong Traditional Chinese Medicine Hospital, Guangdong Province, China
(1) Prevention of predisposing factors
At present, it is believed that infection, especially viral infection, is the main factor causing this disease. About 80% of patients with acute type have a history of upper respiratory tract infection 1 to 2 weeks before the onset of the disease, and patients with chronic type are often aggravated by the infection, and may also be in remission because the infection is controlled. The main viral infections are human immunodeficiency virus (HIV), microvirus B19, herpes virus (HHV), EBV, hepatitis virus, and Helicobacter pylori. Viral infection is mainly through the immune mechanism, the formation of anti-platelet antibodies, so that a large number of platelets destroyed, but also can directly damage the megakaryocytes, so that platelet production is reduced. Therefore, prevention of this disease starts with active prevention of infection and removal of causes or triggers to prevent or reduce the occurrence of the disease.
Avoiding sexual promiscuity, prohibiting illegal blood collection, paying attention to safe blood transfusion and avoiding close contact with hepatitis patients are necessary to prevent HIV infection and hepatitis virus infection, while once HIV infection or hepatitis virus infection occurs, it should be promptly isolated and treated in hospital. Participate in necessary physical activities to enhance physical fitness, actively prevent and control colds and eliminate chronic inflammatory lesions, such as tonsillitis, dental caries, sinusitis, etc. Paying attention to environmental and dietary hygiene and increasing the body’s resistance are beneficial to the prevention of various infections. Chronic gastritis and ulcer pain are often combined with Hp infection, commonly used triple therapy including a proton pump inhibitor such as omeprazole and two antibiotics such as amoxicillin and metronidazole, 7 days as a course of treatment, repeat treatment if necessary.
Female patients should withhold pregnancy and use strict contraceptive measures to avoid aggravation of the disease due to pregnancy and wait until the disease is in remission or cured before pregnancy is appropriate.
(2) Restrict activities and avoid trauma
Patients with acute and chronic exacerbation of the disease should rest in bed, limit activities and avoid trauma, especially pay attention to protecting the head from shock or fall to avoid intracranial hemorrhage. It is appropriate to rest peacefully or sit quietly, avoid strenuous activities, maintain emotional stability, and avoid mental stimulation such as great joy and grief. Pay attention to the arrangement of normal work and rest time, avoid staying up late, overexertion and strain. Avoid straining to have a bowel movement. If the bowel movement is dry, take laxatives or laxative. Inpatients should carefully observe their condition, pay attention to the bleeding site, bleeding volume, degree of anemia, etc. Pay special attention to the presence of intracranial hemorrhage symptoms such as irritability, headache, drowsiness, coma and convulsions. Patients with bleeding tendency and low platelet count should try to avoid myeloablative drugs, tooth extraction, tonsil removal and other procedures. The chronic period of this disease should prevent all kinds of trauma, the skin mucosa should be kept clean, avoid scratching the skin, clothing to loose and soft, avoid rough and tight clothing rubbing the skin, so as not to aggravate the purpura.
If the diagnosis of acute idiopathic thrombocytopenic purpura must be hospitalized, because although the disease has a self-limiting course and often tends to heal itself, but the bleeding performance is generally more serious, the risk of intracranial hemorrhage is large, and therefore can be life-threatening, so it must be treated as an emergency hospitalization. The chronic idiopathic thrombocytopenic purpura, although the bleeding manifestations are generally not too heavy, but easy to recur, not easy to cure, often suddenly aggravated by certain factors, so patients should not be paralyzed because of long-term disease without obvious discomfort, nor should they be upset and bored because of the long-term disease does not heal, should treat the disease correctly, regular recheck platelets, actively cooperate with doctors treatment, avoid strenuous exercise and Avoid strenuous exercise and mood swings to prevent intracranial hemorrhage, especially when the disease suddenly worsens, you should seek medical treatment and pay attention to personal protection. If the platelets are high and there is no bleeding tendency, exercise can be done according to the physical condition.
(3) Early detection, early diagnosis and early treatment
Acute type patients often have upper respiratory tract infection and bleeding occurs afterwards, so bleeding should be noticed after upper respiratory tract infection and the disease can be detected earlier, which is mainly seen in children. The earliest manifestations are: (1) unexplained (a few are after touching), painless skin bleeding spots or bruises, which some people often find unintentionally when bathing; (2) easier gum bleeding than usual when brushing teeth; (3) unexplained increased menstrual flow in women than before, etc. Once these conditions occur, you should immediately go to the hospital to check the platelets, and if the platelets are reduced you should go to the hospital for further diagnosis and treatment.
(4) Use drugs carefully
Drugs that cause thrombocytopenia and impair platelet function should be avoided. Use with caution drugs that can reduce platelets, such as sulfonamides, antipyretic and analgesic drugs, quinidine, promethazine, digoxin, etc. Be cautious with drugs that inhibit platelet function, such as pansentin, aspirin, dextran, pautazone, p-aminosalate, rifampin, chlorothiazide, digitalis, cephalexin, etc. Use anticoagulants such as common heparin and low molecular heparin with caution.
Although glucocorticoid treatment for idiopathic thrombocytopenic purpura therapy is effective, but long-term application of large amounts or sudden discontinuation of the drug will produce many serious adverse reactions, so it must be strictly under the guidance and supervision of the doctor’s medication, do not increase or decrease or discontinue the hormone drugs on their own, and in the process of medication at any time to observe whether there are the following reactions: (1) the use of glucocorticoid therapy, after a period of time with the drug often appetite, pay attention to Pay attention to the appropriate diet and do not overeat to prevent the body from gaining too much weight. After medication, changes in appearance such as centripetal obesity, thinning of the skin and acne often occur, but they will recover slowly after stopping the medication, so be prepared for this. (2) Prevent infection. Treatment with hormones can induce and aggravate infections, so patients should take measures to prevent infections. Those who have already suffered from infectious diseases, such as tuberculosis, should inform the doctor in time so that anti-infection and other treatment measures can be taken at the same time, or hormone drugs can be stopped if necessary. (3) Application of the drug may also cause side effects such as peptic ulcers and bleeding, hypertension, diabetes, osteoporosis, and mental disorders, and should be used with caution or disabled for those suffering from these diseases. Observe for the appearance of symptoms of the above diseases in the course of drug use. (4) For patients who use glucocorticosteroids for a long time or continuously, if the dosage is reduced too quickly or stopped suddenly, it will lead to the recurrence or aggravation of the original disease, and may also cause many adverse reactions. Therefore, the medication should be administered strictly according to the doctor’s requirements and in accordance with the dosage.
(5) Dietary care
Avoid eating hard and coarse food, fried food or stimulating food, which can easily form oral blood blisters and even induce gastrointestinal bleeding. Eat more food containing vitamin C and P. When there is gastrointestinal bleeding, more attention should be paid to diet regulation, and fasting should be given according to the situation, or enter the liquid food or cold liquid food, and the bleeding situation will improve before gradually changing to less residue semi-fluid, soft rice, general food, etc. At the same time, alcohol should be prohibited. If there is bleeding of oral mucosa and gingiva, oral care should be strengthened to prevent oral infection and gargle with compound boric acid solution regularly. If there are blood bubbles in the gingiva and tongue, small blood bubbles usually do not need to be treated. For large blood bubbles that affect eating, a sterile empty needle can be used to aspirate the accumulated blood, and local pressure is applied with gauze rolls until the bleeding stops.
When using adrenocorticotropic hormone treatment, one must strictly follow the doctor’s prescriptions and cannot increase, decrease or stop taking the drug without authorization. The diet should be light and nutritious, avoid aromatic, spicy and fire-engineering products, do not eat cold, greasy and hard food, avoid shrimp, clams, fish and other fishy seafood, should eat more peanuts, red dates, walnuts, cinnamon, lentils and other products that benefit qi and nourish blood. In the chronic period, the spleen and kidneys are deficient, and there is a deficit of Qi and blood, so the diet should be warm, such as chicken, dog, cow, sheep and pork, eel, crucian carp, carp, squid, etc., as well as milk, eggs, fresh vegetables and fruits. Usually as a snack can also be taken to benefit the blood, spleen blood porridge, astragalus porridge, etc., can also be used as a peanut shell decoction for tea, has increased the role of platelets. Commonly used therapeutic recipes are as follows.
(1) Jujube lotus root soup. Lotus root 250 grams, dates 1000 grams. Decoction of lotus root until sticky, then add jujube and decoct, remove lotus root and eat jujube, 10 pieces each time, 2-3 times a day, for 2-3 months.
(2) peanut and jujube juice. Peanut rice 50g, jujube 30g. soak peanut rice in warm water for half an hour, take the skin, jujube washed and soaked in warm water, boil the peanut coat and jujube for half an hour with the water soaked in medicine, remove the peanut rice coat, add appropriate brown sugar. This is the amount of 1 day, divided into 3 times to drink the juice to eat dates and peanuts together.
(3) sheep backbone soup. Sheep backbone (with tail) 1, cistanches 10g, cuscuta 10g, onion, ginger, salt appropriate amount. Crush the sheep spine into pieces; Cistanches wine soak overnight, scrape off the rough skin; Cuscuta wine soak 3 days to dry, pounded, appropriate amount of water, put the sheep spine and Cistanches, stewed together until cooked, seasoned with cuscuta seeds and seasonings. This is the amount of 1 day, divided into 2 times to eat on an empty stomach.
(4) White foxglove stewed pig skin. 30g of white foxglove root, 500g of pig skin, appropriate amount of rock sugar. White foxglove root cloth decoction, take the juice, and then the juice instead of water, decoction of hair cleaned pig skin, stewed until the soup is thick and sticky, mixed with rock sugar. This is the amount of 1 day, divided into 4 to 5 meals.
(5) wolfberry ginseng date egg soup wolfberry 10g, red dates 10, ginseng 10g, 2 eggs. Put the wolfberry, red dates, ginseng into a casserole with the soup, eggs cooked shelled eggs, and then cooked for a few moments, eat eggs and drink soup. This is the amount of 1 day, divided into 2 times to eat.
(6) round meat peanut soup. Longan meat 12g, 25g of peanuts with clothes, 15g of jujube, remove the core of the jujube, boil with peanuts and longan meat with water and then eat. This is the amount of 1 day, divided into 2 times to eat.
(6) medicine for platelets
(1) buffalo horn 30-60g. Cut the buffalo horn into thin slices, add water and boil for 2 hours, and serve in 2-3 times. This formula clears heat and cools the blood to stop bleeding, and is suitable for blood-heat delusion type thrombocytopenic purpura.
(2) Two fresh drinks: fresh thatch root 1509 (chopped), fresh lotus root 20() (sliced). Boil pairs often drink, 4 to 5 times a day. This formula has the function of cooling blood and nourishing Yin, eliminating blood stasis and stopping bleeding.
(3) Prickly vegetable drink: fresh prickly vegetable pounded juice, and into a little yellow wine, 1 small cup each time, 2 to 3 times a day. This formula has the function of cooling the blood and stopping bleeding.
(4) Lotus root and cypress drink: 500 grams of raw lotus root and cypress leaves. Pound to extract juice, add warm water and take 3 to 4 times a day. This formula has the function of cooling the blood to resolve blood stasis and stopping bleeding by astringency.
(5) 30 grams of Colla Corii Asini, appropriate amount of yellow wine and red sugar. Add gum to a small amount of yellow wine and water, put it on a pot of water and stew it, then mix in red sugar. Take 2 times daily for 7 days. This formula nourishes yin and reduces fire and is suitable for thrombocytopenic purpura caused by yin deficiency and internal heat.
(6) Chicken Blood Vine 30g, Angelica Sinensis 12g, Shangluo (first decocted for 3 hours) 20g, Tombou Hui 23g, Xianhe Cao 30g, Phellodendron Bark 15g, Sheng Huangqi 120g, Shengdi 60g, Sheng Licorice 30g. Take with water decoction, I dose per day, divided into 2 doses. This formula tonifies qi, cultivates spleen, activates blood circulation and resolves blood stasis, and is suitable for thrombocytopenic purpura of spleen deficiency and blood heat with blood stasis.
(7) Astragalus, Radix Codonopsis, Radix Angelicae Sinensis, 20g each, Nutmeg, Radix Rehmanniae, 18g each, Cinnamomum, Radix Rehmanniae, 12g each, Chinese yam, 15g, Cynanchum, 30g, Colla Corii Asini (melted), 12g. Decoction with water, 1 dose per day, divided into 2 doses.
(8) Red date and tortoise jelly: 50 grams each of Radix et Rhizoma Dioscoreae, Semen maltodon, Colla Corii Asini, Colla Corii Asini and rock sugar. First of all, the raw earth yellow, maidenhair, red dates boiled with water to get thick juice, discard the dregs of the red dates left for another meal. Add 100 ml of water to the gum and turtle shell gum, and steam them under water. Pour the juice into the medicine with 50 grams of rock sugar, 20 ml of yellow wine, slow fire to collect the paste. Take 20 ml each time, 3 times a day. This ointment is suitable for Yin deficiency and labor heat type thrombocytopenic purpura. It is not suitable for those with deficiency cold diarrhea of the intestines and stomach and those with external cold-heat not yet cleared.