Treatment of thrombopenia
Clear results of treatment of thrombopenic diathesis, regardless of its pathogenesis, with drugs such as ACTH, cortisone, prednisone or their derivatives. In children cortisone is used in a dosage of 100 mg intramuscularly, ACTH in a dose of 50-100 units.intramuscularly( 4 times) or.10-20 units in a 5% glucose solution for 8-12 hours. Doses of prednisone averagely 20-30 mg. The action of these hormones is complex;The fastest way is their non-specific effect on the throughput of small vessels. The latter significantly alleviates the symptoms of diathesis. In the later period of the disease, a significant increase in the number of platelets may occur, which is associated with stimulation of the platelet-forming function of the bone marrow and inhibition of the process of their destruction.
In acute thrombopenia in children and newborns, treatment with hormone preparations of the adrenal cortex is effective. In chronic cases, treatment can be not only inconclusive, but even sometimes harmful. It is obvious that in each case of thrombopenic diathesis it is necessary to reveal its causes, as the latter not only predetermine the behavior of the doctor and the methods of treating the patient, but also determine the prognosis of the disease.
Thrombopenia in newborns, due to the presence of antiplatelet antibodies transmitted through the placenta by the mother, does not need treatment. Genetically determined thrombopenia is an irreversible disease. This diathesis requires depending on the degree of its intensity, periodic blood transfusions, or transfusions of platelets and the use of hormones. It is inadvisable in the usual thrombopenia to produce a splenectomy, which is indicated in the case of essential thrombopenia.
With essential thrombopenia, the main treatment is now reduced to: a) conservative treatment, b) surgical treatment( splenectomy).
Conservative treatment is reduced to blood transfusions in silicate equipment, platelet suspension and hormone therapy( ACTH, cortisone, prednisone and similar drugs).The tactics of the doctor in some cases should be very cautious. In the case of essential thrombopenia, an improvement occurs and bleeding stops when ACTH or cortisone is administered at the indicated dosage. With severe anemia after bleeding and menacing shock, blood should be poured, bearing in mind that the patient needs to deliver intact platelets( silicate equipment).With severe bleeding, the suspension of platelets is poured. In acute essential thrombopenia, all symptoms after 1 or 2 weeks disappear.
In acute cases, splenectomy is usually not performed, since this surgery is risky, conservative treatment methods( hormone therapy) have undoubted effect. It is known that in acute cases self-healing occurs. However, sometimes acute cases turn into chronic cases. In exceptional cases with continuous bleeding or when a bleeding threat exists, splenectomy is performed in the brain, and then only when the entire arsenal of conservative agents is exhausted. In any case, before resolving the issue of splenectomy, the child should be monitored for at least 4-6 months and even more, in the hope that correctly conducted conservative treatment will lead to the desired recovery. This observation is also necessary for the production of necessary studies and the detection of the cause of thrombopenia.
Splenectomy with appropriate indications is performed even in newborns. This operation is carried out now in the treatment of chronic forms of essential thrombopenia. Splenectomy should however be performed only when conservative treatment does not have an effect, and the symptoms of diathesis increase. It should be remembered that blood or platelet transfusions, as well as hormone therapy, are not specific methods of treatment, although they cause improvement and allow postponing surgical intervention.
In some cases, conservative treatment may be sufficient to remove a child from a state of progressive diathesis.
In general it is necessary to take as a basis that essential thrombopenia begin to be treated with hormones. An insufficiently deliberate decision on splenectomy in newborns and young children, subsequently sensitizes them to infectious diseases, which are difficult.
As is known, the spleen due to the large accumulation of REEC cells.and the lymphatic system takes part in various protective functions of the body. This protection is carried out by the spleen with various mechanisms, such as by forming antibodies, phagocytosis, etc. Apparently, the spleen is one of the main organs that produce antibodies. On the special protective role of the spleen in childhood, there are cases of severe infections in children who have undergone, for various reasons, splenectomy and observed in the period from 2 months to 3 years after the operation.
Indications for splenectomy are: 1) a protracted form of essential thrombopenia, accompanied by bleeding and remission, when all the therapeutic agents are exhausted and the disease progresses;2) the sharply protracted form of essential thrombopenia, in which bleeding does not cease within 4-6 months and its causes are not identified, and when vigorous hormonal treatment did not produce an effect, blood transfusions, conducted for several weeks, and, finally, when bleedingthreatens the child's life.
When deciding on splenectomy, it is necessary to take into account the state of the bone marrow. It is generally believed that the best results of splenectomy are obtained when the bone marrow contains either a normal or increased number of megakaryocytes. Authoritative authors believe that the indicator just described is not absolute.
In 70% of essential thrombopenia, splenectomy gives a clinical and hematological improvement. Usually, bleeding stops after the ligation of the spleen's legs, and the platelet count increases during the first 24-48 hours, and then 10 days later it exceeds the original digits. However, in a later period, the number of platelets gradually decreases, sometimes to low digits. Despite this, the general condition of children is good and the symptoms of diathesis either completely disappear or remain insignificant. In some cases, many years after splenectomy, the number of platelets is kept at a normal level or slightly below it. In other patients, hemorrhagic diathesis recurred at different times after splenectomy. Also described after splenectomy( after a while) cases of cerebral hemorrhage, although immediately after the operation there was an improvement. In the majority of operated cases, there was a noticeable clinical improvement and even a cure.
Unfortunately, there are still no specific indicators that would allow us to foresee the results of the operation.
The prognosis of for essential thrombopenia in children is favorable, over the years the tendency to bleeding decreases. The prognosis of girls is much worse - they have a danger of profuse bleeding of their sexual organs in the period of sexual development.
Women's magazine www. BlackPantera.en: Magdalena Berger