1.Basic information of aplastic anemia
Aplastic anemia (abbreviated as reanemia) is a disease in which anemia, hemorrhage and fever occur due to biological, physical and chemical factors or unknown reasons, which cause bone marrow hematopoietic failure resulting in a decrease in whole blood cells. There are two main clinical types: acute and chronic. The annual incidence rate in China is 0.74 per 100,000 population. Xiping Dai, Department of Hematology, Guangdong Provincial Hospital of Traditional Chinese Medicine
Aplastic anemia is a typical hematopoietic failure disease, which is difficult to treat clinically, has a long period and is harmful to human beings. Measures and methods such as supportive treatment, combined treatment, long-term treatment, and combined treatment of Chinese and Western medicine should be insisted on in order to achieve good results.
2.Principles and methods of health care for aplastic anemia
(1) Early detection, early diagnosis and early treatment
Once high fever, infection and bleeding symptoms are found, you should immediately go to the hospital for examination, with a view to early diagnosis and early treatment. Bone marrow aspiration is the main method to diagnose aplastic anemia, and patients and family members should actively cooperate with doctors without fear. Patients often feel uneasy and fearful because of the rapid onset of the acute form of the disease, so they should be concerned and considerate to help them establish confidence to overcome the disease. Therefore, it is important to prevent infections. Pay attention to keep the skin and mouth clean, bathe and change clothes, brush teeth and rinse mouth, and turn the patient regularly to prevent bed sores. Keep the bowels open to avoid anal abscesses and ulcers. Patients with high fever should be given physical cooling and drink more water to promote the excretion of toxins in the body. Patients with acute recurrent disease are prone to bleeding, so they should pay attention to protection, avoid squeezing, bumping, falling and trauma, etc. Keep the living room clean, fresh air, sufficient sunlight, and regular ultraviolet disinfection indoors, and patients should not go to public places as much as possible to reduce the chance of infection. It can be combined with diet and medicinal food therapy, eat more foods rich in vitamin C and K such as fresh vegetables, fruits, eggs, pig liver, etc., and reasonable deployment, and also try human placenta powder, which has the effect of benefiting qi and nourishing blood, tonifying liver and kidney.
(2) Etiological prevention and treatment
According to the known pathogenic factors of this disease, corresponding preventive measures can be used to reduce the incidence. Drugs that are damaging to the hematopoietic system should be strictly controlled in terms of indications and dosage and duration of treatment, and blood images should be tested frequently in the course of use. Viral infections can be secondary to reoccurrence, so we should actively prevent and treat viral hepatitis and other viral infections, such as mumps, measles, dengue fever and influenza. The details are as follows.
(1) There are two types of drug-induced reoccurrence: the first one is related to the drug dose, and the drug will cause myelosuppression when it reaches a certain dose. This condition is generally reversible, such as various antitumor drugs such as antitumor (cytotoxic) drugs, such as 6-mercaptopurine, methotrexate, vincristine, marilyn, melphalan, cyclophosphamide, cytarabine, methotrexate, nitrosoureas, onychomycetes, inorganic arsenic. In addition phenytoin sodium, phenothiazine, thiouracil and chloramphenicol can also cause dose-related bone marrow suppression. The second has little to do with drug dose, and hematopoietic disorders occur in only a few patients who use the drugs, often leading to persistent reoccurrence. There is a wide range of drugs in this category, including antibiotics: chloramphenicol, co-trimoxazole, penicillins, tetracycline, streptomycin, amphotericin B, kanamycin, oxytetracycline, sulfonamide; anticonvulsants: methadone, trimethoprim, phenytoin sodium, paracetamol; antipyretics and analgesics: pautazone, aminopyrine, anandamide, aspirin, paracetamol; antithyroid drugs: methylphenidate, tapazole; hypoglycemic drugs: toluene Anti-tuberculosis drugs: isoniazid; psychostimulants: dormant, Librium; insecticides: DDT, etc.; antimalarial drugs: Adipine, chloroquine; diuretics: acetazolamide. To prevent the occurrence of pharmacogenic recurrence, the following points should be noted: ① Strictly grasp the indications for the use of drugs, especially for chloramphenicol, which can be replaced by other drugs as far as possible. ②Patients with the application of drugs that damage bone marrow hematopoiesis should be closely observed hematologically, and bone marrow examination should be done if necessary. Once a decreasing trend of white blood cells and vacuoles in the cytoplasm of bone marrow young red blood cells are found, the drug should be stopped in time. ③Promote the importance of using medication under the guidance of a physician to patients who visit the clinic. ④Advise that some drugs, such as chloramphenicol, should not be sold freely in the outpatient department.
(2) Do occupational protection and avoid exposure to harmful chemicals. Try to avoid contact with chemicals and pesticides known to cause reoccurrence in life (such as paints, glues, organic solvents and pesticides, etc.). Choose qualified products from regular manufacturers for home decoration materials, and keep the air circulating after the decoration is completed and do not move in immediately. Long-term exposure to pesticides can also cause re-infestation, so we should carry out in-depth education on protective health knowledge and must take necessary protective measures when using pesticides to eliminate the occurrence of pesticide poisoning in order to reduce the incidence of re-infestation.
For the work needs, must contact these harmful chemicals, must strictly implement the protection measures to prevent harmful substances pollution of the environment and human body. For example, factories should replace benzene with low or non-toxic substances, reform production processes and ventilation and detoxification, install local extraction and detoxification equipment with sufficient effect, and operational workers should wear anti-toxic masks or use face masks, etc.
(3) do a good job of ionizing radiation protection. For those who work with radiation or ionizing radiation, strengthen protective measures to avoid the occurrence of chronic external exposure, and the resulting reoccurrence will be possible to prevent. Poor protective measures, long-term, super-permissible amount of radiation exposure can lead to the occurrence of reoccurrence. Prevention of ionizing radiation should be done: ① stay away from radiation sources, try to avoid unnecessary ionizing radiation, such as not to do too close X-ray physical examination, housing construction away from nuclear power plants, high-voltage substations, etc. ②Strengthen labor protection, due radiation shielding protection for personnel engaged in nuclear industry, ray work, radioactive particles and other industries, wear lead clothing, protective gloves, etc. (3) Consciously reduce computer and cell phone radiation on a daily basis, such as reducing the time spent on computers and keeping cell phones away from the body the moment they are connected.
(4) Prevention of infection. Certain infectious diseases can be secondary to reoccurrence, for example, among viral infections, infectious hepatitis is the most frequent complication of reoccurrence, often called hepatitis-related reoccurrence. The disease is more common in young men, mostly develops during the recovery period of hepatitis and has a poor prognosis. The etiology of hepatitis-associated reoccurrence is mostly thought to be due to hepatitis virus invasion of the bone marrow and damage to the bone marrow microenvironment, which prevents stem cell proliferation and differentiation and leads to reoccurrence. In view of the fact that infection can be secondary to reoccurrence, strengthening physical exercise, regular life, relaxed spirit, combined work and rest, and proper nutrition can enhance physical fitness and effectively prevent the occurrence of infection. It is found that some patients with reoccurrence have a history of cold before the onset of reoccurrence, which means that some reoccurrence can be secondary to cold. Therefore, active prevention and treatment of colds is also important to reduce the occurrence of reoccurrence.
(3) Strengthen supportive therapy and prevent infection and bleeding
Blood transfusion should be actively carried out to prevent and treat infection and bleeding to avoid aggravating the disease.
(1) Regular daily life, pay attention to rest, regular living and relaxation. Pay attention to increasing and decreasing clothes to avoid getting cold and flu. Do personal hygiene, keep skin clean, bathe, change clothes and cut nails regularly. Ventilate the room regularly, keep the room clean, disinfect the air every day, go to public places less often, and wear a mask when going out. Encourage patients with no obvious bleeding tendency to participate in outdoor activities, such as walking, tai chi, etc., to get in touch with sufficient sunlight, breathe fresh air, and combine movement and stillness to cooperate with treatment, so as to facilitate early recovery. Avoid intercourse and stop smoking and drinking.
(2) Pay attention to oral cleanliness and anal hygiene. Insist on gargling after meals and before going to bed to prevent oropharyngeal ulcers, commonly used gargling solutions include saline, compound boric acid solution, 1% hydrogen peroxide, sodium bicarbonate solution, etc.; insist on sitting in a bath with 1/5000 potassium permanganate solution after stool to prevent necrotic ulcers and perianal abscesses around the anus that can lead to sepsis. If necessary, protective isolation can be taken to actively prevent infection. Dietary hygiene is crucial, do not buy unhygienic food outside, melons and fruits should be washed and peeled before consumption, and female patients should pay attention to perineal cleanliness. If sore throat, cough, runny nose, painful urination, swollen gums, redness and swelling occur, go to hospital for early treatment.
(3) Prevention of bleeding. Move appropriately according to the condition and prevent slipping or trauma when moving to avoid bleeding after injury. (1) Prohibit brushing teeth with a hard-bristled toothbrush, picking teeth with a toothpick, eating slowly, and avoiding damage to the oral mucosa and gums caused by eating fried foods or chewing hard fruits. ②Prevent dryness of the nasal mucosa, apply oil for protection if necessary, and prohibit digging the nostrils to avoid damaging the nasal mucosa and causing bleeding. ③ Pay attention to the color of urine, and female patients pay attention to the amount and time of menstruation. If headache, dizziness and nausea occur, go to hospital for examination and treatment in time. ④For oral bleeding, first dip soft paper gently to remove the blood, then rinse the mouth with water and find the bleeding point to stop the bleeding. To stop gum bleeding, use haemostatic cyclic acid injection with twice the amount of saline to gargle 3 to 4 times a day. Alternatively, hemostatic cyclic acid can be mixed with Yunnan Baiyao and applied externally to the gums. In addition, local application of gelatin sponge can have better hemostatic effect and is mostly used for those who bleed more than once. ⑤ Pay attention to the patient’s bleeding tendency, such as skin and mucous membrane bleeding, epistaxis, gum bleeding, fundus bleeding, etc., and give symptomatic and hemostatic treatment. ⑥ For patients with severely reduced platelets, appropriate platelet transfusion, systemic application of hemostatic drugs such as hemostatic min, vitamin K1, and oral administration of Anluo blood, Yunnan Baiyao, etc. can be used to stop bleeding. (7) In case of gastrointestinal hemorrhage or risk of intracranial hemorrhage, various rescue drugs and supplies should be prepared to assist in resuscitation. (8) In case of extensive bleeding of skin and mucous membranes, pay attention to maintaining the integrity of skin and mucous membranes to prevent infection, and in case of high fever and heavy sweating, change clothes in time to avoid catching cold.
(4) Diet to produce blood
Give high protein, high vitamin, easy to digest food, such as lean meat, eggs, dairy, chicken, rib soup, animal liver, fresh vegetables and fruits, more dates, cinnamon garden, peanuts, walnuts, lotus root, etc. to produce blood and stop bleeding; for those who have a tendency to bleed, give a semi-liquid diet without residue, eat less food with spines and bones to prevent bleeding and infection caused by spines. Avoid spicy and stimulating foods (raw onion, ginger, garlic, chili, etc.), seafood, mutton, dog meat and other hot foods, avoid smoking and alcohol, cold and greasy.
Eat in moderation, avoid over-starvation and over-feeding, if necessary, a small number of meals. Yin deficiency should be clear tonic avoid warm tonic, Yang deficiency is warm tonic avoid cold, both Yin and Yang deficiency should be prohibited tobacco and alcohol and spicy fried dry food, so as not to dry spicy fire, help blood delusion. And depending on the condition of the following dietary therapy formula for long-term use.
① wolfberry bean bone soup: 250 grams of raw pork bones, 15 grams of wolfberry, 30 grams of black beans, 20 dates. Stew the above ingredients into water until cooked, seasoning food. Take 1 every other day, can be long-term service.
② hen placenta soup: one hen, placenta, 200 grams of red peanuts, 200 grams of red beans, 200 grams of walnuts, 200 grams of black sesame seeds, 200 grams of red dates. Cut the hen into pieces, chop the placenta and boil the soup with water, then add red dates, red peanuts, red beans, walnuts and black sesame seeds to the soup and cook for about 1 hour. Finish eating in 3 days. It nourishes Yin and warms Yang, replenishes Qi and nourishes Blood, suitable for patients with Yin and Yang deficiency of remittance.
Mutton, yam and cordyceps soup: 750g mutton, 4g cordyceps, 30g yam, 10g wolfberries, 6g ginger, 3g jujube, salt. The lamb washed and cut into pieces, into the boiling water blanching, and cleaned cordyceps, yam, wolfberry, ginger, dates together into a casserole, add the right amount of water, with a large fire boil and then change to a low fire stew 3 hours, seasoned with refined salt is ready. As a dish to accompany the meal, feel free to eat. It can warm the spleen and kidney, benefit essence and nourish blood, and is suitable for patients with spleen and kidney Yang deficiency.
4) Cordyceps with bone marrow: 4 grams of Cordyceps, 6 grams of yellow essence, 3 grams of peel, 250 grams of raw bone marrow, salt and monosodium glutamate. Wash cordyceps, yellow essence, peel and bone marrow with water respectively. Add the right amount of water in the pot, boil with high heat, put Cordyceps, yellow essence, peel and beef marrow, change to low heat and continue to boil 3 hours, add salt, MSG seasoning before serving. Eat as much as you like, and finish it in two days. Nourishing the liver and kidney, nourishing blood and benefiting essence. Suitable for patients with liver and kidney Yin deficiency.
(5) Cordyceps, river carp and ox marrow paste: Cordyceps 30g, purple river carp 30g, ox marrow 250g, yam and honey 250g each, grind cordyceps and purple river carp into fine powder and add it to the paste made by pounding wai yam and ox marrow, stir well, put it in a porcelain jar, add honey, then put it into a pot and stew it for 2 hours with low fire.
(5) Emotional and spiritual care
Adverse mental factors, such as excessive sadness, depression and anger after the disease, can increase the mental burden of patients, interfere with normal diet and sleep, reduce the immunity of the body, and easily lead to infections and even serious complications such as cerebral hemorrhage, etc. Maintaining a good mental state and optimistic mood is the key to effective treatment. Patients with reoccurring disorders should not be angry, so as not to cause coughing up blood, vomiting blood, cerebral hemorrhage, etc.; avoid long-term depression and depression, which will affect the function of spleen and stomach and liver qi, and make the blood image recover slowly or deteriorate.
Patients with reoccurrence have a long treatment period, and they need to adhere to long-term consolidation and maintenance treatment after the effect is obtained. This requires warm care for patients, helping them to understand the disease correctly and build up confidence to overcome the disease, to be determined to actively cooperate with the treatment, to be persistent in the treatment, and to be patient in long-term treatment in order to achieve remission and even cure. It is extremely important for the family members to provide good life care, and to create a clean, fresh air, pleasant environment and happy atmosphere for the patients, which is conducive to the recovery of the disease.
Patients should be encouraged to adhere to maintenance treatment. The three systems of red blood cells, white blood cells and platelets in patients with aplastic anemia are not recovered simultaneously, but there are some first and some second, some fast and some slow, some easy and some difficult. Generally speaking, the order of recovery of the three systems in effective cases is: red blood cells, white blood cells and platelets, among which platelets are more difficult to recover, but there are a few cases in which the three systems do not recover. If the blood picture is restored, the drug is stopped and the treatment cannot be maintained, and the relapse rate is high. Generally, after the normalization of blood picture, it takes one year to maintain treatment in short cases, and more than three years in long cases, but the number of drugs and dosage form can be reduced, and the condition is stable without relapse. In short, maintenance treatment time should be formulated according to different situations. Maintenance treatment is indispensable to reduce the recurrence rate and improve the long-term efficacy are of great significance.
(6) Medicine for blood production
(1) Compound Saponin Pill. Ginseng 120g, seahorse 30g, soap alum 120g, oil laurel 60g, walnut 60g, jujube 60g, one seven-inch snake. Method: steamed dates, crushed into a paste, ginseng, seahorse baked dry, plus the rest of the drugs crushed into powder, then the powder and the date paste, made into pills, about 3-5 grams per pill, 3 times a day, each time 1 pill, after meals with warm water. Individuals with mild nausea, stomach discomfort, or mild diarrhea after taking the drug, can be reduced by half for 3 to 5 days, nausea symptoms can disappear, and then take the amount. Avoid tea. Effects: Warming the kidney and strengthening the marrow, benefiting the qi and nourishing the yin, producing blood and stopping bleeding. Indications: Aplastic anemia, leukopenia, thrombocytopenia, myelodysplastic syndrome and radiotherapy and chemotherapy-induced bone marrow damage, leukopenia is a deficiency of kidney yang, Qi and blood deficiency evidence.
(2) Placenta powder. Take one fresh placenta, roast it on a gentle fire, and grind it into powder, 2-3 grams per serving, twice a day, with 15 grams each of angelica, astragalus and shouwu in decoction. Effects: Tonifying the kidney, benefiting the essence, benefiting the qi and nourishing the blood. Indications: Deficiency of kidney energy, deficiency of essence and blood, impotence and spermatorrhea, lumbar soreness and tinnitus, or infertility; deficiency of qi and blood, emaciation and less food, body fatigue and weakness, or less milk after childbirth; deficiency of both lungs and kidneys, shortage of breath.
(3) 60 grams of beef marrow, 60 grams of cinnamon meat and 60 grams of jujube meat, boiled into gelatinous form and taken twice a day, 1 spoonful each time. Effects: Tonifying kidney and filling essence, benefiting qi and nourishing blood. Indications: deficiency of essence and blood, lumbar soreness and weakness, dizziness and dizziness or deficiency of qi and blood, yellowish face, tiredness and fatigue, palpitation when moving, skin petechiae, poor appetite, etc.
(4) 250g of beef marrow, 250g of yam, 30g of Cordyceps sinensis, 30g of placenta, pounded together and 250g of honey into a magnetic jar, then stewed in a pot with water for 30 minutes, 2 spoonfuls each time, twice a day. Effects: Filling in the marrow and tonifying the lung, spleen and kidney. Indications: deficiency of essence and blood, deficiency of the lung, spleen and kidney, see lumbar soreness and weakness, dizziness and tinnitus, impotence and spermatorrhea, or female infertility, short breath, breathing more and sucking less, especially when moving; deficiency of qi and blood, yellow face and emaciation, tiredness and weakness, palpitation and palpitation, loose stools, etc.
For kidney yin deficiency, the symptoms are dizziness, tinnitus, lumbago, fever in the hands and feet.
For kidney-yang deficiency, the symptoms are pallor, lumbar pain, chilliness and coldness in the extremities. 10 grams of Radix Bupleuri, 10 grams of Epimedium, 12 grams of Semen Cuscutae, 10 grams of Cistanches, 6 grams of Radix Aconiti, 6 grams of Cinnamon, 10 grams of Bacopa monniera, decoction, one dose per day.
In case of spleen and kidney yang deficiency, the symptoms are mostly white face, cold extremities, poor appetite, loose stools, long clear urine, weakness of limbs, etc. The medicine uses 30 grams of Radix et Rhizoma Ginseng, 10 grams of Atractylodes Macrocephala, 15 grams of Radix Astragali, 15 grams of Yam, 10 grams of Poria, five jujubes, and combine with the above kidney yang tonics as appropriate, decoction, one dose per day.
In case of Yin-Yang deficiency, the symptoms are white face, tiredness, weakness, weakness of the waist and knees, hot flashes and night sweats, insomnia and dreaminess, or cold abdomen and loose stools, etc. We can use Yin-Yang tonic products, including 10 grams of Radix et Rhizoma Polygonati, 6 grams of Cinnamon, 20 grams of Radix Rehmanniae, 15 grams of Huai Shan, 15 grams of Cornu Cervi Pantotrichum, Poria and Fructus Lycii, decoction, one dose per day.