How to treat idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura is a clinical syndrome caused by abnormal immune function leading to increased platelet destruction. For treatment, it is recommended that patients with acute bleeding be hospitalized and avoid reducing activities at night.

1. General treatment: During acute bleeding, hospitalization is appropriate. Minimize activity and avoid trauma. When bleeding is obvious, bed rest is required. Actively prevent and control infections and avoid taking drugs that affect platelet function (such as aspirin, etc.)

2. The main pharmacological effects of glucocorticoids are: reducing capillary permeability, inhibiting the production of platelet antibodies, and inhibiting the monocyte-macrophage system from destroying antibody-adsorbed platelets. Prednisone is commonly used, with a dose of 1.5-2 mg/kg per day, taken orally in 300 divided doses. For patients with severe bleeding, shock therapy can be used: dexamethasone 0.5-2 mg/kg per day, or methylprednisolone 20-30 mg/kg per day, intravenous drip, for 3 consecutive days. After the symptoms are relieved, prednisone is taken instead. The dosage can be gradually reduced when the platelet count returns to near normal levels. The course of treatment generally does not exceed 4 weeks. If relapse occurs after stopping medication, prednisone can be used again for treatment.

3. The main effects of high-dose intravenous immunoglobulin are: 1. Blocking macrophage receptors, inhibiting the binding and phagocytosis of platelets by macrophages, thereby interfering with monocyte-macrophage receptors, inhibiting the binding and phagocytosis of platelets by macrophages, thereby interfering with the phagocytosis of platelets by monocytes. ② Form a protective film on the platelets to inhibit the binding of IgG or immune complexes in the plasma to the platelets, thereby preventing the platelets from being destroyed by phagocytes. ③ Inhibit autoimmune reactions and reduce antiplatelet antibodies. The platelet-raising effect of large-dose intravenous drip of immunoglobulin alone is similar to that of hormones. The commonly used dose is 0.4g/kg per day, intravenous drip for 5 consecutive days, or 1g/kg each time intravenous drip. If necessary, it can be used again the next day, and then once every 3-4 weeks. It has few side effects and occasional allergic reactions.

4. Platelet transfusion: Because the blood circulation of children contains a large amount of antiplatelet antibodies, the transfused platelets are quickly destroyed. Therefore, platelet transfusion is usually not recommended. Platelet transfusion is only given when internal bleeding or acute massive internal bleeding occurs and life is endangered. At the same time, large doses of adrenal cortex hormones should be given to reduce the destruction of transfused platelets.

5. Anti-D immunoglobulin is also called anti-Rh globulin. Its mechanism of action is not yet fully understood. Its main function is to block the Fc receptors of reticuloendothelial cells. Its effect of increasing platelets is slower than that of hormones and high-dose immunoglobulin G, but lasts longer. The commonly used dose is 25-50 μg/kg per day, intravenously injected, and one course of treatment is 5 consecutive days. The main side effects are mild hemolytic transfusion reactions and positive Coombs test.