Autoimmune hemolytic anemia

 Since autoimmune hemolytic anemia is not a disease but a common symptom of certain diseases, the principle of treatment is to remove the cause first. If the anemia is severe, it is necessary to adopt blood transfusion to directly correct the anemia or temporarily reduce the anemia. 1. Etiology treatment:    actively seek out the cause, treat the primary disease, and most of the AIHA caused by infection can cure secondary ovarian cysts, teratomas, etc., which can be cured after surgery. Patients with secondary tumors of the hematopoietic system should be treated at the same time Reinforceable pine, most patients require long-term treatment.  2, adrenal corticosteroids:    conventional drugs, the mechanism of treatment is that corticosteroids inhibit macrophage’s ability to eliminate antibody-attached red blood cells, or reduce the effect of antibody binding to red blood cells, or inhibit antibody production. Generally, the ability of the reticuloendothelial system to clear red blood cells sensitized by antibodies or complement is reduced in 4 to 5 days after the medication. After the hormone is removed, about 10-16% of patients can get long-term relief. If the treatment fails for 3 weeks, the traditional Chinese medicine method needs to be changed in time. The occurrence of infection often induces hemolysis to increase, increase the dose, and strengthen targeted antibiotic treatment.  3, immunotherapy:    is contraindicated in spleen-removal for those who are ineffective in treatment or who must rely on high-dose hormones to maintain, or if spleen-removal is ineffective. During the treatment, the blood picture must be observed and checked at least once a week, and attention should be paid to bone marrow suppression and serious infection.  4, spleenectomy:    is suitable for primary warm body antibody AIHA, aged over four years, those who are ineffective or dependent on hormone therapy, those who are ineffective in immunosuppressive therapy or have obvious side effects. The long-term effect of intrasplenic embolism is not as good as splenectomy. In clinical practice, the general indications of splenectomy are:   A, corticosteroid treatment ineffective or contraindications;   B, need high-dose corticosteroid maintenance;   C, hemolysis often recurring;   D, corticosteroids plus immunosuppressant treatment invalid By.  5, other treatments:   A, high-dose gamma globulin;   B, anti-lymphocyte globulin;   C, danao, the effective mechanism may have an immunomodulatory effect;   D, vincristine;   E, plasma exchange method. The principle of blood transfusion for AIHA patients is to avoid blood transfusion as much as possible without blood transfusion, and wash red blood cells should be transfused when necessary. Cold antibody AIHA: mild patients do not affect labor. Need to keep warm. Cold agglutinin disease mainly treats the primary disease, and the prognosis is also related to the primary disease. Transfusion should be cautious when there is obvious hemolysis, because the red blood cells of normal donors are more susceptible to cold antibody damage. When cold antibodies are present, it is difficult to match blood. You can follow the warm antibody type AIHA blood transfusion program to infuse concentrated red blood cells under warmth to overcome tissue Hypoxia. There is still a need for immunosuppressive agents to inhibit the production of antibodies, which can be used in the rescue of critically ill patients.

Hu Guisheng, Beijing Hematology Hospital: Patients with thrombocytopenia need to be cautious when “cutting the spleen”

Assistant Hu Guisheng WeChat: dd326751 Article source: Reposted from the WeChat public account [Hu Guisheng Studio] Thrombocytopenia patients and their families are looking for better treatments, and at the same time, they will more or less understand that the spleen is removed and the word “spleen cut” is caused To the attention of patients, when should the spleen be cut? Is it necessary to cut the spleen for treatment? What is the effect of spleen surgery? The relevant analysis is carried out below.   When will it be recommended to cut the spleen:    1. All conventional Western medicine therapeutic drugs are ineffective, including first-line drugs such as hormones and gamma globulin, and second-line drugs such as cyclosporine, azathioprine, danazol, vincristine, etc. are all ineffective.  2. Active and progressive bleeding states such as acute bleeding, life-threatening hemorrhage, intracranial hemorrhage, etc., persist and cannot be effectively controlled.   After cutting the spleen, the number of platelets will increase significantly in a short time, and then gradually decrease until it returns to normal, which shows that the spleen cutting treatment is effective. However, the treatment of spleenectomy is only for patients whose platelets are mostly destroyed in the spleen. For patients with thrombocytopenia caused by other factors, the effect is not very obvious, or even ineffective. At the same time, the spleen is the largest immune organ in the human body. During the recovery period after splenic incision, the patient has a certain chance of infection, and it will affect the patient’s own immunity and be vulnerable to other diseases. The last point is that patients with thrombocytopenia after spleen cut treatment may not have a good long-term prognosis. A few patients relapse again within a few years after spleen cut! This point is still a treatment point that requires continuous attention and improvement in medicine. Generally speaking, for patients with spleenectomy and recurrent thrombocytopenia, it is necessary to receive Chinese medicine intervention in time, instead of fishing for three days and two days of sun exposure. Net, we must carefully choose targeted hospitals, experts and treatment methods. Because there are indeed patients whose spleen cut is ineffective and get normal and stable values ​​after stopping the drug through combined Chinese and Western therapy.