Purpura is the most common clinical manifestation of hemorrhagic diseases. Once purpura is found, the following possibilities are suggested:
① Vascular purpura. The most common diseases are vascular wall injury or increased fragility and permeability, which are common in immunity (such as allergic purpura), infection (such as sepsis), abnormal vascular structure (such as hereditary hemorrhagic telangiectasia) and other diseases (such as abnormal proteinemia, simple or senile purpura, etc. ). Check that there is no abnormality except that the beam arm test may be positive.
② Platelet abnormal purpura. The most common is caused by thrombocytopenia or increase and abnormal function. If purpura or blood blister appears in the oral cavity and buccal mucosa, it often indicates serious bleeding and should be treated actively.
③ Obstacles in coagulation mechanism, including lack of coagulation factors, anticoagulant substances in circulation or hyperfibrinolysis. Generally speaking, the bleeding caused by the disorder of coagulation mechanism is mainly manifested as joint hematocele, muscle hematoma and visceral bleeding, with less skin purpura and only large ecchymosis. Moreover, the coagulation picture is obviously abnormal, which can be distinguished from purpura and platelet abnormality caused by vascular purpura. The treatment of purpura varies according to illness.
1 Causes of Purpura Bleeding
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(1) Vascular system diseases, such as damage to the vascular wall or increased permeability and brittleness of the vascular wall, lead to the leakage of red blood cells in the blood and form purpura. Lack of bacterial toxins, chemicals and vitamins can lead to vascular injury. Such as simple purpura, allergic purpura, allergic purpura with increased intravascular pressure.
(2) Bleeding caused by coagulation disorder. Such as thrombocytopenic purpura, hemophilia, fibrinogen-reducing purpura, prothrombotic purpura caused by liver disease, and purpura caused by excessive anticoagulant drugs.
The above lesions not only lead to skin bleeding, but also lead to other tissues and internal organs bleeding. Purpura should not only consider bleeding, but also carefully examine the organs of each system to rule out blood system diseases. There are also some special types of purpura, such as rheumatic purpura and thrombotic purpura. , need a system check to find out the cause and symptoms. Therefore, purpura should not be taken lightly.
There are many ways to classify purpura, which can be divided into thrombocytopenic purpura and non-thrombocytopenic purpura according to general habits. Some people divide it into inflammatory purpura and non-inflammatory purpura according to the changes of blood vessel wall. Others are classified according to etiology and clinical manifestations. Common purpura and its classification are as follows:
2 the cause of the disease
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(1) The etiology of simple purpura is unclear, generally mild, with no obvious changes in blood vessels and occasional slight coagulation dysfunction.
Henoch-Schonlein purpura
Henoch-Schonlein purpura
(2) Henoch-Schonlein purpura often occurs due to the increase of permeability and brittleness of blood vessel wall, and the vascular system changes, but the blood itself does not change. Therefore, the number of platelets, coagulation time and prothrombin time are all in the normal range. It is a vascular allergic disease, because the body reacts to some allergens, which leads to the increase of capillary fragility and permeability, blood extravasation, skin, mucosa and some organs bleeding and other allergic manifestations.
(3) Idiopathic thrombocytopenic purpura, also known as hemorrhagic purpura, the cause of which is unknown. However, antiplatelet factors can be found in the blood of some patients, which can reduce platelets and lead to bleeding. It is a hemorrhagic disease in which platelet immunity is destroyed and platelets in circulating blood are reduced. It is characterized by extensive bleeding of skin mucosa and organs, thrombocytopenia, normal or increased number of megakaryocytes in bone marrow with maturity disorder, shortened platelet life and anti-platelet antibodies.
Idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura
Positive is the characteristic. More common in children and young adults, women are more than men.
3 Classification of Purpura
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(1) Purpura simplex generally has no systemic symptoms, and bright red petechiae scattered about the size of a needle can appear on both lower limbs, which will not fade after pressing. After seven days, the color gradually faded. But there are new petechiae.
(2) Idiopathic thrombocytopenic purpura can be divided into acute type and chronic type. Acute type is rare, can occur in children, and often has a history of infection before onset. The characteristics of the disease are sudden onset, fever, extensive bleeding of the skin, massive ecchymosis, hematoma, bleeding of mucous membrane and urogenital tract, and obvious decrease of platelets, which can be less than 5000 /mm3. Chronic type is more common, more young women, slow onset, continuous or repeated bleeding. It not only occurs in the skin, mucous membrane or internal organs, but also bleeds in severe cases.
(3) Rheumatic Purpura has slight ecchymosis of the size of rice grains on both lower limbs, and ecchymosis, wheal or edematous erythema may also appear. At the same time, joint swelling and pain can occur, and systemic symptoms such as fever and limb weakness can also occur.
(4) The skin manifestations of abdominal purpura are the same as those of rheumatic purpura, but there may be abdominal pain, vomiting, diarrhea, acute diarrhea, stool bleeding and other symptoms, and severe cases may be complicated with intussusception.
Symptoms of purple epilepsy and allergic purple epilepsy
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The diseases that cause subcutaneous hemorrhage are collectively called purpura, and most of them are allergic purpura (Scheer-Heinz disease) caused by vascular system disorder and primary thrombocytopenic purpura caused by thrombocytopenia.
Henoch-Schonlein purpura (Henoch-Schonlein purpura) is a systemic acute reaction in allergic reaction (allergic reaction), which is an allergic disease caused by injection of horse serum to treat diphtheria. Similar to the symptoms of this vascular purpura. So it was named after allergic purpura.
Henoch-Schonlein purpura
Henoch-Schonlein purpura
purpura
purpura
5 Purpura in children
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Purpura, also known as purple spot, is a common disease in children's hemorrhagic diseases. The clinical manifestations are bleeding under the skin mucosa, petechiae and ecchymosis, and the color does not fade after pressing. This disease mostly occurs in school-age children and is common in thrombocytopenic purpura and allergic purpura in western medicine.
Purpura in children
Purpura in children
Diagnostic points of purpura in children
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The onset is more acute, with recurrent purpura, which can occur in the skin and mucous membranes of all parts of the body. Rashes are varied, ranging from pinprick-like to ecchymosis or hematoma, and can also be fused into blocks. The color of the rash is reddish or bright red at first, and it will not fade after pressing. After a few days, it will turn into lavender and light blue, and gradually fade. Acute onset is often accompanied by nosebleed, bite, bloody stool, hematuria or vomiting, abdominal pain, joint swelling and pain and other symptoms. This disease belongs to the category of blood syndrome and should be differentiated from the macula caused by fever. The occurrence of febrile diseases is mostly related to the abnormal qi at four o'clock and is not contagious. First, high fever and headache, then rash, acute onset, rapid spread, and even coma and convulsions. Laboratory examination: if thrombocytopenia, prolonged bleeding time, normal coagulation time, poor contraction of blood clot, positive anti-platelet antibody test and positive beam arm test, it is suggested that it is thrombocytopenic purpura; If the platelet count, bleeding time, coagulation time and blood clot contraction are normal, it indicates allergic purpura.
purpura
purpura
purpura
purpura
Infectious purpura
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introduce
Infectious thrombocytopenic purpura is caused by bacterial, viral and fungal infections, among which viral infection is the common cause of thrombocytopenia. The bleeding symptoms of infectious thrombocytopenic purpura are generally mild, and sometimes there are no bleeding symptoms. However, there are also virus infections, such as epidemic hemorrhagic fever and infectious mononucleosis, which can lead to a significant decrease in platelets and severe bleeding symptoms.
pathogenesis
The pathogenesis of infectious thrombocytopenic purpura varies with the pathogen and the severity of infection. Generally speaking, the possible mechanism of the disease is that megakaryocytes are directly damaged, resulting in thrombocytopenia; Pathogen directly destroys or consumes platelets, shortens platelet survival time, and immune mediates platelet destruction. The details are as follows:
1, virus. Virus infection is the main cause of acute idiopathic thrombocytopenic purpura in children. Virus infection can directly damage megakaryocytes, resulting in a significant decline in bone marrow megakaryocytes.
2. bacteria. Many bacterial infections can cause thrombocytopenia, and disseminated intravascular coagulation caused by severe bacterial infections is one of the mechanisms leading to thrombocytopenia. In addition, bacterial invasion into bone marrow and the toxic effect of gram-negative bacterial endotoxin on bone marrow megakaryocytes are also the mechanisms leading to thrombocytopenia caused by bacterial infection.
Prevention of Purpura in Children
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Henoch-Schonlein purpura is caused by many reasons, such as infection, food (milk, eggs, fish and shrimp, etc. ), drugs (antibiotics, sulfonamides, antipyretic and analgesic drugs, etc. ), pollen and mosquito bites.
Generally speaking, 85% of allergic purpura is related to infection. If you have upper respiratory tract infection, tonsillitis, dental caries, intestinal parasitic diseases, etc. You should treat in time and actively look for allergens, which can be detected by biological detectors or blood tests.
Usually pay attention to avoid contact with these substances that can cause allergies. If it is related to a certain food, you should fast. If it is related to drugs, it should be stopped. If it is related to the environment, it should be avoided. While actively taking medicine, careful nursing is very important for the prognosis of this disease.
9 Other therapies for children with purpura
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1. External treatment: 0/5g of white grass/kloc-,30g of keel, 30g of dried alum, * * * ground into fine powder, and then dipped with a wet cotton swab for nasal congestion.
2. Acupuncture therapy
(1) Acupoints: Zusanli, Quchi, Hegu and Xue Hai. Suitable for allergic purpura.
(2) Ear acupuncture takes spleen, endocrine, adrenal gland, lung, etc. Suitable for allergic purpura.
3. Diet therapy
Peanut coat jujube soup: peanut coat 5- 10g, jujube 10g, codonopsis pilosula 15g. Decoct with water, daily 1 dose. It is suitable for purpura with qi failing to absorb blood.
Jujube Shengdi Drink: 65,438+00 jujubes, 30 grams of Radix Rehmanniae, 65,438+00 grams of Arnebia euchroma and 65,438+00 grams of Glycyrrhiza uralensis Fisch, which are decocted in water to make tea.
Qiangen Shuiyu Soup: 1 Shuiyu (soft-shelled turtle), Qiangen 10g, Agrimonia pilosa 10g, and proper amount of seasoning. Can you fish in water? Wash, stir-fry the roots and hairs of Agrimonia pilosa, remove residues, stew fish in water and add seasonings. 1 Dose Take 8- 10 continuously every day or every other day. It is suitable for purpura with yin deficiency and excessive fire.
Cogongrass rhizome drink: buffalo horn 30g, radix rehmanniae 15g, cortex moutan 10g, cogongrass rhizome 15g, and proper amount of sugar. Decoct with water, daily 1 dose. It is suitable for purpura caused by blood heat rash.
Introduction to 10
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Purpura simplex refers to a hemorrhagic disease that has no other symptoms, appears spontaneously and repeatedly in the skin, especially in the lower limbs, and can disappear without treatment. The etiology and pathogenesis of the disease are still unclear. It may be caused by abnormal capillary wall. The beam arm test was positive, and other hemostasis functions were normal. No bleeding occurred in internal organs and other parts. This disease often occurs in a family. Mainly seen in women, men are rare. Because this disease is sexual orientation, and mainly appears before menstruation, it may be related to endocrine. In addition, it has also been suggested that abnormal platelet function in some patients is also one of the mechanisms leading to this disease.
This disease is mainly manifested as bleeding symptoms, especially skin bleeding spots and bleeding spots, so it belongs to the scope of "purple spots". There is a profound understanding of the physiology and pathology of blood in the medical work Neijing. For example, "On the Nose" says: "The essence is also in harmony with the five zang-organs, and it can be distributed in the five zang-organs, so it passes through the five zang-organs with the pulse." This "camp" refers to "blood" It is pointed out in the summary of blood loss in medical records that "skin bleeding is called muscle bleeding". As for the pathogenesis of this disease, The Surgical Authentic Grape Epidemic says: "The abnormal qi at four seasons lingers on the skin, forming green spots, and the color is like grapes ...". Zhu Danxi thinks that the hair spots are mainly caused by excessive heat, and Danxi's hand mirror says that "hair spots are also hot". Regarding the location of the disease, there is a clear understanding of the location of the disease in Jin Jian of Medical Zong, Heart of Surgery and Grape Epidemic: "It occurs all over the body, but mostly in the leg gaskin". Physicians in the past dynasties have their own advantages in treating "blood syndrome", which is described more completely in The Complete Book of Jingyue in the Ming Dynasty. Zhang Jingyue pointed out: "Those with blood deficiency and slight fever should be cooled and supplemented"; "If blood is due to qi deficiency, it should be supplemented with qi"; "If there is chaos in the blood, it is the sum of the officials and the Qing Dynasty." In Tang Rong's theory of blood syndrome, he put forward four steps to treat blood, pointing out: "Only stopping bleeding is the first important method. After the bleeding stops, it is blood stasis that stays in menstruation but doesn't spit it out ... So eliminating blood stasis is the second method. After stopping vomiting and removing blood stasis, drugs are needed to stop blood from flowing again, so the method of calming blood is the third method. When evil is put together, the right thing will be empty. Removing more blood, yin is not empty, is a method of tonifying deficiency and collecting. The four are the guidelines for treating blood syndrome. " In the Song Dynasty, represented by Taiping Shenghui Prescription, there were many prescriptions mainly for clearing away heat and toxic materials, cooling blood and eliminating spots.
1 1 etiology and pathogenesis
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(A) feel the external evil
Pulse is the house of blood, and blood circulates in the pulse, nourishing viscera, flesh and blood, bones and muscles. Exogenous evil invades and turns into heat toxin, burning pulse, heat driving blood crazy, blood overflowing pulse, forming muscle spasm.
(2) Fatigue and chronic illness
Excessive fatigue, injury to the spleen and stomach, or chronic illness due to spleen deficiency will make the spleen weak, and the spleen will not control blood, which will lead to muscle bleeding. Long-term illness injures yin, body fluid is not abundant, yin deficiency and fire are flourishing, and deficiency fire forces blood to flush blood.
(3) Internal resistance of blood stasis
Repeated bleeding, or qi deficiency, poor blood circulation, or yin damage to body fluid, can not bring blood to the whole body, leading to blood stasis, new blood is not born, blood does not return to the meridian, overflow outside the pulse, resulting in bleeding. For example, Lingshu Jing said: "If the hand is deficient in yin, the pulse will be blocked, and the blood will not flow if the pulse is blocked."
Clinical manifestations of 12
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(1) Heat-induced bleeding
1 main symptoms: acute onset, short course of disease, sometimes accompanied by fever, blue spots or patches on the skin, mostly in the lower limbs, dry throat, thirst, yellow throat, irritability, restless night sleep, sometimes accompanied by aversion to cold, fever, headache, joint pain, red tongue, yellow fur, floating pulse or rapid pulse.
Syndrome analysis: pathogenic heat is abundant in the interior, forcing blood to rush to ren, and blood overflows into the skin, forming muscle spasm. Internal heat stagnation will cause fever; When the body fluid is exhausted by heat, the throat is thirsty; Disturbed by heat, the gods are restless; Heat turns bladder muscles yellow; The evil of wind and heat attacks the exterior, and the good and evil contend. If the camp is not in harmony with the guard, it will produce aversion to cold and fever, headache and joint pain. Tongue pulse belongs to heat image.
(2) Deficiency of kidney essence
1 Main symptoms: purple spots on the skin, soreness and weakness in the waist and knees, tinnitus, feverish hands and feet, hot flashes and night sweats, menorrhagia, dreaminess at night, red tongue with little fur, and heavy pulse.
Syndrome analysis: chronic illness fatigue, kidney essence failure, deficiency fire blazing inside, burning pulse, forcing blood to rush to ren, so purple spots on the skin occur from time to time; The waist is the home of the kidney, and the kidney begins to understand the ear. Kidney deficiency leads to soreness in the waist, weakness in the knees and tinnitus. Kidney governs uterus, and kidney yin is insufficient. Deficiency will hurt the pulse, and collateral rupture will lead to blood overflow, leading to menorrhagia. Virtual fire disturbs the mind, and when you are distracted, you dream more at night; The remaining syndromes, tongue and pulse are all symptoms of deficiency of kidney yin.
(3) Deficiency of both qi and blood
1 main symptoms: scattered purple spots on the skin, recurrent attacks, pale color, shortness of breath, fatigue, anorexia, pale face, dizziness and palpitation; The tongue is pale, the coating is thin and white, and the pulse is thin and weak.
Syndrome analysis: Qi handsome is blood, pneumatic is blood, qi deficiency is blood out of control, blood does not follow menstruation, so the skin is purple and white; Repeated bleeding, qi goes with blood, leading to deficiency of qi and blood, malnutrition of viscera, meridians and limbs, so fatigue and shortness of breath; Lack of effort, palpitations when the heart loses support; Empty malnutrition will make you dizzy; Blood deficiency can lead to pale tongue and white face, and insufficient pulse can lead to weak pulse.
(4) Internal resistance of blood stasis
1 main symptoms: purple skin, dark red color, dizziness, palpitation, especially when moving; Or accompanied by low fever, fever in hands and feet, emaciation and dry eyes; But it is light in weight, with ecchymosis and petechiae, and the pulse is fine and astringent; Or red tongue, ecchymosis or ecchymosis, thin pulse.
Syndrome analysis: repeated bleeding and blood stasis hinder the growth of new blood; Or vaginal fluid loss, blood vessels are not full, so that blood circulation is not smooth, resulting in blood stasis. Symptoms of dizziness, palpitation, exercise, especially deficiency of qi and blood; Low-grade fever, fever of hands and feet, emaciation and dry eyes are the symptoms of yin deficiency of liver and kidney; Pale tongue, thready pulse, ecchymosis on tongue, blood deficiency and blood stasis; Red tongue, ecchymosis and thready pulse are symptoms of yin deficiency of liver and kidney.
13 diagnosis and differential diagnosis
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[diagnosis]
Characteristics of 1: Patients with excessive heat and blood overflow belong to excess syndrome and heat syndrome, sometimes accompanied by a history of exogenous diseases; The other three types of recurrent attacks. The purple spots on the skin are sometimes heavy and sometimes light, the disease develops slowly, the course of disease is long, and the accompanying symptoms are mild, which is often ignored.
2 Syndrome characteristics
(1) The skin is blue-purple spots or patches with different shapes, which are hidden in the skin, so it may interfere with the touch of hands.
(2) Common in limbs, especially lower limbs.
(3) Women are more common, and menstrual period is aggravated with menorrhagia. .
(4) Self-healing tendency.
(5) The course of bleeding is short except for blood fever, and the onset is urgent. Other types of bleeding have long course, recurrent attacks and a chronic process.
differential diagnosis
Erysipelas: It is a surgical disease, so it is named because the skin is as red as red erysipelas. Light pressure will fade, but the color will not fade under heavy pressure, but the local skin will be hot and red, which is different from purple spots.
14 western medicine diagnosis and differential diagnosis
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[diagnosis]
Clinical manifestations of 15 1
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Spontaneous slight skin ecchymosis or ecchymosis, mainly in lower limbs, upper limbs occasionally, trunk rarely, no inducing factors. The ecchymosis or ecchymosis is uneven in size and distribution, does not rise above the surface, and does not fade or hurt when pressed. Before ecchymosis appears, there may be slight pain locally. I often feel dull pain in my leg skin when I dress the next morning, and I found ecchymosis after examination. If left untreated, the ecchymosis can subside by itself, leaving a blue-yellow pigment patch, which will gradually disappear later. Purpura often recurs and gets worse during menstrual period. Patients generally have no bleeding from internal organs or other parts. Mucosal bleeding is rare, sometimes there is a small amount of bleeding in the gums, increased menstrual flow and prolonged menstruation. The amount of bleeding during tooth extraction, surgery, trauma and delivery can be slightly more, but it will not cause serious bleeding.
162 laboratory test
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(1) The beam arm test was positive or negative, but the routine examination of hemostasis function was normal.
(2) A few patients had abnormal platelet aggregation induced by ADP and epinephrine, and the adhesion rate to glass beads column decreased.
3 diagnostic criteria
(1) has been in good health. Most of the lower limbs spontaneously appear ecchymosis or ecchymosis, which can disappear by itself. No family history.
(2) The beam arm test is positive or negative, but the routine examination of hemostasis function is generally normal.
(3) Purpura caused by other reasons can be excluded.
17 differential diagnosis
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Aspirin-like defect: 1 is an autosomal dominant genetic disease with platelet release dysfunction. Patients are particularly sensitive to aspirin; Platelet count is normal; The effectiveness of PF-3 is abnormal. Clinical epithelial lesions are unevenly distributed, mucosal bleeding is obvious, and bleeding is more serious during trauma or operation.
2 Mild von Willebrand disease: there is mucosal or visceral bleeding. The bleeding time of some patients was prolonged; Aspirin tolerance test was positive; ⅷ: C decreased, ⅷ R: Ag decreased obviously; Platelet adhesion rate can be reduced; Platelet aggregation of listeriomycin is weakened.
Henoch-Schonlein purpura: It is a vascular allergic hemorrhagic disease, that is, immune vascular disease. There are usually symptoms of fever, infection and general malaise. Purpura is distributed symmetrically in limbs and appears in batches, and ecchymosis and ecchymosis are mainly on the extension surface of hands and feet. Often accompanied by abdominal pain. Joint pain or swelling, bloody stool, hematuria and edema in some patients. Laboratory examination showed that platelet count, bleeding and clotting time, blood clot retraction test were normal, bone marrow examination was normal, and bundle arm test was positive.
Results and prognosis of 18
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The prognosis of this disease is generally good and will not cause serious harm to health. Mild purple spots can heal themselves without treatment. If it is a new disease, it belongs to excessive healthy qi and excessive pathogenic factors. If treated correctly, 1 month can be cured. However, this disease is a recurrent process, with long course, mixed deficiency and excess, and dysfunction of viscera, which should be actively treated to avoid syndrome changes over time.
19 nursing
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Enhance physical fitness and prevent the invasion of external evils; People with yin deficiency in diet should avoid spicy food; People who repeatedly bleed should live a good life and not be too tired, so as not to aggravate their condition.
20 prevention
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Because this disease is spontaneous bleeding, there is no obvious inducement and no obvious accompanying symptoms, which brings certain difficulties to prevention. According to the pathogenesis of this disease in traditional Chinese medicine, measures should be taken to strengthen physical fitness, live moderately, work hard in a hurry, and pay attention to rest after the onset.
Thrombocytopenic purpura is characterized by significant thrombocytopenia, accompanied by cutaneous mucosal purpura. In severe cases, bleeding may occur in other parts, such as nosebleeds, gingival exudation, menorrhagia or severe hematemesis, hemoptysis, hematochezia and hematuria. Intracranial hemorrhage is the fatal cause of this disease. Henoch-Schonlein purpura is characterized by scattered spots on the skin of limbs or spreading to the whole body. Severe cases are accompanied by joint pain or abdominal pain, bloody stool, vomiting blood, collapse and so on. In severe cases, it can develop into henoch-schonlein purpura nephritis.
Thrombocytopenic purpura can be divided into primary and secondary.
Primary thrombocytopenic purpura is an immune syndrome and a common hemorrhagic disease. It is characterized by the existence of anti-platelet antibodies in blood circulation, which makes platelets destroy too much and causes purpura; However, the megakaryocytes in bone marrow are normal or increased, which is childish. Clinically, it can be divided into acute and chronic, and its pathogenesis and manifestations are obviously different. The acute type is mostly 10 children, and there is no gender difference. Most cases occurred in winter and spring, and there was a history of virus infection before illness. Most cases were upper respiratory tract infection, rubella, measles and chickenpox. After vaccination, the incubation period of infection and purpura is mostly within 1~3 weeks. Adult acute type is rare, often related to drugs, and the condition is more serious than that of children. Have a sudden fever. Mainly skin and mucous membrane bleeding, often more serious. Skin bleeding is petechiae with different sizes and uneven distribution, which mostly occurs in limbs. Mucosal bleeding includes nosebleed, gingival bleeding, oral and tongue mucosal blood bubbles. There are often gastrointestinal bleeding, urinary tract bleeding, subconjunctival bleeding and a few retinal bleeding. Common spinal cord or intracranial hemorrhage can cause paralysis of lower limbs or intracranial hypertension, which can be life-threatening. Chronic type is more common, accounting for 80% of primary thrombocytopenic purpura, and most of them are 10~40 years old, and women are 3~4 times as many as men. Sneak when you are sick. Patients may have persistent bleeding or recurrent attacks, and some may show local bleeding tendency, such as recurrent epistaxis or menorrhagia. Congestion and ecchymosis can occur in any part of skin and mucosa, but more often in distal limbs. There may be gastrointestinal and urinary tract bleeding. Deep hematoma can also occur after trauma. Intracranial hemorrhage is rare, but it can still occur during acute attack. You can occasionally touch the spleen when inhaling deeply. The etiology and pathogenesis of primary thrombocytopenic purpura have not yet been clarified. It is considered as an immune-related disease. At present, the first choice for western medicine to treat thrombocytopenic purpura and allergic purpura is hormone. Platelets can generally increase after taking it, but the side effects of hormones are very great. While increasing platelets, it will also increase many new diseases, such as centripetal obesity, hypertension, diabetes, osteoporosis and so on. After reducing the dosage of hormone, platelets will drop again, and will still recur after stopping taking the drug. Splenectomy is dangerous and difficult for patients to accept. Spleen is the immune organ of human body. After splenectomy, the patient's immune function is low, which is easy to cause serious infection and bring great pain to the patient's body and mind. The recurrence rate after splenectomy is about 58%.
2 1 chronic type
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Common in young women, women are 3 ~ 4 times as many as men. The onset is hidden, the symptoms are mild, and there are often repeated bleeding, and each bleeding lasts for several days to months. The degree of bleeding is related to platelet count. Platelets > 50× 10/L are often bleeding after injury. Platelets can have spontaneous bleeding in different degrees between (10 ~ 50 )×10/L. Platelets smaller than 10× 10/L often have severe bleeding, and patients are in good condition except bleeding symptoms.
22 acute type
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It is common in children, accounting for 90% of cases of immune thrombocytopenia, and the incidence of male and female is similar. 84% of the patients had a history of respiratory tract or other virus infection within 1 ~ 3 weeks before onset, so the onset was the most frequent in autumn and winter, including fever, chills and cutaneous mucinous purpura. If the patient has headache and vomiting, be alert to the possibility of intracranial hemorrhage. The course of the disease is mostly self-limited, and more than 80% can relieve itself, with an average course of 4-6 weeks. A few can be delayed or become chronic for more than a few years. Acute type accounts for less than 65438 00% of adult ITP.
Signs of primary thrombocytopenic purpura
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1. Chronic type
Cutaneous purpura is more common in the distal end of lower limbs, and bleeding is more common in nasal cavity, gums and oral mucosa. Women's menstruation is sometimes the only symptom, and repeated attacks can cause anemia and mild splenomegaly. If there is obvious splenomegaly, the possibility of secondary platelets should be ruled out.
2. Urgent type
It can suddenly appear extensive and serious skin mucosal purpura, and even a large area of ecchymosis and hematoma. The ecchymosis of the skin is mostly systemic, mostly in the lower limbs and evenly distributed. Bleeding is more common in the nose, gums and mouth, and there may be blood bubbles. Gastrointestinal and urinary tract bleeding is not uncommon, and intracranial bleeding is rare, but it is life-threatening. The spleen is often not swollen.
Syndrome Differentiation of Purpura 24
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1. Aspirin-like defect: It is an autosomal dominant hereditary disease with platelet release dysfunction. The patient is particularly sensitive to aspirin, with normal platelet count and abnormal efficacy of pF-3. Clinical epithelial lesions are unevenly distributed, mucosal bleeding is obvious, and bleeding is more serious during trauma or operation.
2. Mild von Willebrand disease: mucosal or visceral bleeding. In some patients, bleeding time was prolonged, aspirin tolerance test was positive, ⅷ: C was decreased, ⅷ R: Ag was decreased, platelet adhesion rate was decreased, and platelet aggregation to listamycin was weakened.
3. Henoch-Schonlein purpura is a vascular allergic hemorrhagic disease, that is, immune vascular disease. There are usually symptoms of fever, infection and general malaise. Purpura is distributed symmetrically in limbs and appears in batches, and ecchymosis and ecchymosis are mainly on the extension surface of hands and feet. Often accompanied by abdominal pain. Joint pain or swelling, bloody stool, hematuria and edema in some patients. Laboratory examination showed that platelet count, bleeding and clotting time, blood clot retraction test were normal, bone marrow examination was normal, and bundle arm test was positive.
Treatment of allergic purpura with traditional Chinese medicine
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The basic ingredients are madder 20g, Cimicifuga rhizome 5g, Guanghe 15g, Radix Saposhnikoviae 10g, Colla Corii Asini 15g, Radix Paeoniae Alba 15g, Radix Cynanchi Preparata 15g, Radix Glycyrrhizae 10g and Mume/kloc. Schisandra chinensis 6 fine laundry) earthworm 10g grass field 15g perilla leaf 10g duckweed 10g cicada retreat 10g.
Taking method
Decoct in water for 3 times each time, mix one tablet, and take it in 3 times, 3 times a day, and pay 2 1 for one course of treatment.
job operation
To process the above-mentioned precious medicinal materials with special effects, it is necessary to take bamboo slices as knives, slice them, steam them in charcoal fire, casserole and steamer for 9 times, and then sun them for 9 times before they can be used as medicine.
26 causes of purpura
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1. Infected bacteria (upper respiratory tract infection caused by β hemolytic streptococcus is the most common, in addition to Staphylococcus aureus, pneumococcus and mycobacterium tuberculosis), viruses (rubella, chickenpox, measles and influenza) and intestinal parasites.
Second, eat foreign protein in fish, shrimp, crab, eggs, milk and other foods.
Three, drug antibiotics (blue, chain, red, chloramphenicol), sulfonamides, isoniazid, antipyretic and analgesic drugs (salicylic acid, phenylbutazone, quinine, etc.). ).
Fourth, others such as colds, pollen, insect bites, vaccination, etc. The above factors cause antigen-antibody complex reaction, which deposits on the vascular wall or glomerular basement membrane, activates complement, releases allergens, damages capillaries and arterioles, causes extensive capillary inflammation and even necrotizing arteriolitis, increases the permeability and brittleness of vascular wall, and leads to hemorrhage and edema of subcutaneous tissues, mucous membranes and internal organs. The gastrointestinal tract and joints can have similar changes. Renal lesions are mostly focal mild nephritis, and in severe cases, focal necrosis of glomerular capillaries or whole kidney involvement may occur. Some scholars believe that this disease is an immediate allergic reaction with a large amount of IgE. Adsorbed on mast cells, thus releasing bioactive substances to cause the above damage.