General treatment: In acute cases, severe bleeding occurs mainly within 1 to 2 weeks of onset. Therefore, in the early stages of the onset, activities should be reduced and trauma, especially head trauma, should be avoided. Severe cases should rest in bed. Infections should be actively prevented and controlled. Aspirin can cause bleeding and must be avoided. Give adequate fluids and easily digestible food to avoid damage to the oral mucosa. To reduce bleeding tendency, large amounts of vitamin C and P are often given. For local bleeding, apply pressure to stop bleeding. General cases do not require special treatment. If bleeding is severe or intracranial hemorrhage is suspected, various hemostatic measures should be actively taken. Chronic cases do not require special treatment if the bleeding is not severe or during the remission period. However, trauma should be avoided and infection should be prevented. Sometimes a minor respiratory infection can cause serious relapse. Those with severe bleeding or those who cannot be cured after long-term treatment should receive the following special treatments.
2. Transfusion of fresh blood or platelets: only used as emergency treatment in case of severe bleeding. Due to the presence of anti-platelet antibodies in the patient's blood, the transfused blood can be destroyed quickly and has a short lifespan (a few minutes to a few hours). Therefore, blood transfusion or platelet transfusion cannot effectively increase platelet count. However, some people believe that transfusion of platelets can quickly reduce capillary fragility and reduce bleeding tendency.
3. Adrenocortical hormones: It is generally believed that the efficacy of hormones is due to: ① reducing the permeability of capillaries and bleeding tendencies; ② reducing the immune response, and can reduce the production of PAIgG and inhibit spleen monocytogenes Phagocytosis of antibody-attached platelets by nuclear macrophages. Therefore, after early application of large amounts of hormones in ITP patients, the bleeding phenomenon can improve quickly. It is still advocated that patients whose condition is moderate or above within 1 month of onset (especially within 2 weeks) or whose condition is severe or above despite a long onset time should be given hormone therapy. The principle of medication is early, large amount, and short-term. Generally, prednisone 60mg/m2·d (2mg/kg·d) is taken orally in 2 to 3 times or once in the morning. If the bleeding is severe, prednisone can be taken orally up to 120 mg/m2·d or hydrocortisone 400 mg/m2·d or flumetasone 10-15 mg/m2·d intravenously. When the bleeding improves, it can be changed to prednisone 60 mg. /m2·d. Generally, the medication is taken for about 3 weeks, and the longest is no more than 4 weeks, and the dosage is gradually reduced until the medication is discontinued.
4. High-dose intravenous gamma globulin: For children with severe or severe hemorrhage, high-dose purified gamma globulin (IgG) can also be infused intravenously, about 0.4g/kg·d, for 5 days. . About 70% to 80% of patients can increase their platelet count. However, such refined products are expensive and difficult to promote for a while.
5. Immunosuppressants: Those who are ineffective in hormone therapy can still try: ①Vincristine 1.5~2mg/m2 each time (maximum dose 2mg/time) intravenously once a week; or 0.5~ 0.5mg/m2 each time 1 mg/m2 plus 250 ml of normal saline for slow intravenous infusion, and a course of treatment lasts for 4 to 6 weeks. Platelets can be seen to increase after taking the drug, but most patients decrease again after stopping the drug, and only a few can achieve long-term relief. Because the effect is short-lived, it is more suitable for preparation before surgery. ② Cyclophosphamide 2 to 3 mg/kg·d orally or 300 to 600 mg/m2 intravenously once a week. It usually takes 2 to 6 weeks to be effective. If it is not effective after 8 weeks, the drug can be discontinued. Those who are effective can continue to take the medicine for 4 to 6 weeks. ③Azathioprine 1~3mg/kg·d usually takes one month to be effective. These immunosuppressants can be combined with corticosteroids.
6. Other drugs: In recent years, Danazol (DNZ), a non-masculine synthetic androgen, has been tried at home and abroad to treat patients with refractory chronic ITP. The immediate effect is good and the maintenance effect is short, so it has certain value for those who need to temporarily increase platelets in preparation for splenectomy surgery.
7. Splenectomy therapy: The relief rate of splenectomy for chronic ITP is 70% to 75%. However, the indications for surgery should be carefully understood and the splenectomy time should be postponed as much as possible.