We currently have a number of methods for preparing platelet concentrate. These include: a) Preparation of platelet mass from a cylinder of conserved blood. Take blood using citric acid- citrate dextrose , centrifuge at 800 rpm for 15 minutes, then decant plasma with abundant platelets. Treat all materials used with silicone. The disadvantage of this method is its low productivity; to obtain a sufficiently large number of platelets, it is necessary to use blood from several donors, which increases the risk of viral hepatitis transmission. b) Thrombocytopheresis in plastic bags. Take blood into two special plastic bags, one of them containing citric acid-citrate-dextrose, the other without an anticoagulant . Centrifuge the blood collected in the first bag and then clarify by pressing the platelet-rich plasma in the second bag, which does not contain the anticoagulant . Erythrocyte mass is transfused to the donor. The double procedure of thrombocytopheresis lasts 1-1.5 hours, the yield of the method is 1011 platelets. c) Thrombocytopheresis by centrifugation under continuous flow conditions. Various types of separating centrifuges are used, including Aminco or Latham , and also a continuous flow cell separator such as IBM. The yield is 2.6 X 1011 platelets collected within 2 hours. The disadvantage is the need for heparinization of the donor and the costly separation equipment. The selected platelets are transfused within a maximum of 48 hours or preserved by freezing at low temperatures in the presence of cryophilic substances. It is recommended that the donor does not swallow aspirin at least 72 hours before blood collection.
Transfusion of platelet mass is indicated for severe thrombocytopenia or thrombostenia , accompanied by hemorrhagic phenomena that cannot be treated by other therapeutic methods. Platelets should not be prescribed for disseminated intravascular coagulation syndrome (due to aggravated thrombosis), autoimmune and post-drug thrombocytopenia . There was no direct relationship between vascular platelets and the development of hemorrhagic syndrome. It is generally accepted that mild signs of hemorrhagic syndrome appear when the platelet count is less than 40,000 / mm3, with a level of 20,000 platelets / mm3, the hemorrhagic syndrome is severe. Nevertheless, there were cases of thrombocytopenia at less than 10,000 / mm3, without impaired hemostasis. A transfusion of 1011 platelets / m2 of body area develops thrombocythemia, equal to 12 x 109 platelets / L. blood. Therefore, an adult whose body area is 1.5 m2 needs to be transfused twice a week with 2 x 1011 platelets to maintain a concentration of 20/109 platelets / l. blood. Below is one of the formulas by which the effect of platelet transfusion can be estimated: Growth per m2 of body area = (number of platelets after transfusion – number of platelets before transfusion) / (number of transfused platelets) * patient’s body area. The clinical response to platelet transfusion is assessed by an increase in platelet count and the disappearance of hemorrhagic syndrome. Since platelets contain transfused antigens, a preliminary determination of donor-recipient compatibility in the A VO, Rh and HL-A systems is required. Repeated platelet transfusions incompatible leads to isoimmunization and appearance of antiplatelet antibodies that cause the development of immunity in the patient, and failure of transfusion platelet mass. Such recipients show post-transfusion reactions, the short life span of transfused platelets and persistence of hemostatic disorders. For this reason, it is preferable to transfuse platelets from only one donor, in particular from the patient’s family.
Patient regimen in the treatment of thrombophlebitis. Compression method of treatment
When prescribing treatment for a patient with acute thrombophlebitis, an important place is given to the patient’s regimen. As with any inflammatory process, and with thrombophlebitis, it is necessary to provide rest to the affected organ. For this purpose, even now, bed rest is often prescribed even with thrombophlebitis of varicose veins. However, immobility in bed promotes the spread of the thrombotic process due to a slowdown in blood flow. In order to combine the immobilization of the affected vein with movements, the compression method is used, which is widely used abroad. Sigg , who is an active supporter of this method, indicates that as early as 1923 N. Fischer reported the successful treatment of 2400 patients with thrombophlebitis with compression bandages, in which he did not observe a single case of embolism, and gives a large number of later reports. Elastic compression of the veins promotes faster adhesion of the thrombus to the venous wall, and in the presence of phlebitis, creates local immobilization. An elastic bandage with a placed sponge, which has a fixing effect on the phlebitic area, is applied to the lower leg, and sometimes to the entire limb, and the patient is allowed to walk. Sigg generally objects to bed rest (provided that butazolidine is used ), even with deep vein thrombophlebitis. However, Tournai , one of the prominent phlebologists of France, pointing out the need for active behavior of the patient in acute thrombophlebitis and putting forward the requirement “in no case to make the patient immobile”, at the same time emphasizes that the patient cannot walk for kilometers or do hard work. The author recommends that the patient get out of bed several times and walk with the obligatory fixation of the affected area of the vein.
In addition, with severe pain, he injects a solution of novocaine intra-arterially , and locally applies an ice pack or moist warm (but not hot) dressings, and after the acute events subside, puncture a vein and evacuate a thrombus, followed by wearing a compression bandage. The majority of Russian authors refused to use warming compresses and in the first days of acute thrombophlebitis of superficial veins prefer an ice pack applied to the affected area of the vein for 15-20 minutes several times a day. Cold is contraindicated in cases where thrombophlebitis is accompanied by spastic phenomena of peripheral arteries (V.I. Struchkov, L.T. Lidsky, etc.). The oil- balsamic dressing with Vishnevsky ointment or vegetable oils (corn, olive, sunflower, etc.), which is widespread in medical practice, exerts a slight thermal effect, reduces pain and spastic phenomena. Without the use of additional agents, treatment with oil dressings for superficial thrombophlebitis is long-term, but in some cases, especially at home, it is justified. It is rational to combine such a bandage with a compression bandage with an elastic bandage, so that the patient can get up and walk. With the conservative treatment of superficial vein thrombophlebitis, in most cases there is no need for anticoagulants, except for patients with a high prothrombin index or a tendency to progression of thrombophlebitis, when the appointment of anticoagulants may be rational, with mandatory blood control. Most patients with superficial thrombophlebitis can be successfully treated without antibiotics. The exception is purulent thrombophlebitis, the presence of infected foci, sepsis. Antibiotics are used prophylactically for operations on thrombosed veins. In some cases, it is rational to use new. cain blockades, suppositories, enemas, and inside analgesics (aspirin, pyramidon, etc.).
Indications for the use of estrogens in treatment
Replacement therapy for ovarian hypofunction. In this case, ethinyl estradiol (at a dose of up to 50 μg / day orally for 21 days) is effective, followed by the appointment of a progestogen ( norethisterone or medroxyprogesterone 5 mg / day orally for 7 to 10 days monthly. If ovarian hypofunction is not primary, then treatment is stopped every third menstrual cycle, as spontaneous menstruation may occur.In severe menopause (flushing, vaginal dryness), combined estrogen- progestogen dosage forms are prescribed for a year or longer.Estrogen can be used in cycles or continuously, and progestogen – cyclically In most women, as a result of drug withdrawal, intermittent bleeding is observed.When using branded drugs ( Menophase , Prempak ), various drug regimens are offered.Of estrogens, these drugs include estradiol and conjugated estrogens.In case of vaginal atrophy, ethinyl estradiol should be prescribed only in a low dose (10 μg / day ) during even in these cases, the use of estrogens ( estriol or conjugated estrogens) in the form of creams is preferable . The drugs Orto-Ginest , Ovestin and Premarin contain 0.01% estriol , 0.1% estriol and conjugated estrogens, respectively. Progestogens are used mainly orally; this group includes dihydrogesterone , medroxyprogesterone , norgestrel, and norethisterone . Individual progestogens can be administered orally in combination with subcutaneous estrogen (as a depot) or by transdermal administration . One such application ( Estracombi ) provides the body with both hormones, but it is obvious that their doses cannot be optimally adjusted for each patient. An alternative to estrogen therapy is the drug Tibolone ( Livial ), which is a synthetic steroid with weak estrogenic, progestogenic and androgenic properties. It is taken orally at a dose of 2.5 mg / day . The main side effect is vaginal bleeding, and if it persists , testing is needed. Clonidine ( Dixarit ) in low doses can reduce vasomotor symptoms during menopause. None of these drugs should be prescribed to prevent osteoporosis in postmenopausal women. Dosage forms containing estrogen- progestogens do not provide adequate contraception, therefore, non-hormonal drugs should be used until menopause is completely completed (44 – 55 years).
Hormone therapy using increasing doses of drugs is carried out in the following cases. Postmenopausal hormone replacement therapy has been widespread for many years. In the 1970s, more than 30% of postmenopausal women in a number of developed countries received estrogens in order to improve overall well-being and in the hope of preventing aging processes (the appearance of wrinkles on the face), the development of osteoporosis (which is usually) and cardiovascular diseases (possibly) … Long-term (over several years) estrogen-only therapy, regardless of whether it was carried out continuously or in courses, is accompanied by an increase in the incidence of uterine cancer. Perhaps supplementation progestogen reduces the risk of complications, but if the uterus is removed, but this is not necessary. With long-term (over 5 years) use of these drugs, the incidence of breast cancer in older women increases by about 50%. Thus, the disadvantages and advantages of such therapy should be evaluated if there is evidence of slowing the development of osteoporosis and coronary heart disease. Studies have shown that hormone replacement therapy prevents bone loss during menopause, although it remains unclear whether the incidence of bone fractures is reduced. Data on ischemic heart disease in postmenopausal women taking combination drugs are not yet available; Currently, the assessment is based on indirect evidence such as a decrease in low density lipoprotein (LDL) and plasma fibrinogenesis and an increase in high density lipoprotein (HDL). The duration of such therapy can be up to 10 years or more. Currently used dosage forms containing estrogen- progestogen , for example Menophase , Cyclo- Proginova , do not provide reliable contraception. Women who require surgery should be treated in the same way as patients taking combined oral contraceptives. For contraception and menstrual irregularities see separate article on the website. Vaginitis in old age is an indication for the use of pessaries or estrogen cream. They can also be used for vaginitis in young girls. The drugs are usually absorbed in quantities sufficient to cause systemic effects in both the woman and her sexual partner. Suppression of lactation. For this purpose, estrogens, separately or in combination with progestogens or androgens, have been used for over 50 years. However, these drugs cause thromboembolism, and also stimulate endometrial tissue during the onset of its involution. These agents are now considered obsolete for suppressing lactation. Androgen – dependent carcinoma. Estrogens in high doses are used in prostate carcinoma, which is an androgen – dependent tumor. This inevitably develops feminization and often painful gynecomastia. In order to prevent thrombosis, aspirin is prescribed, which has an antiplatelet effect. To reduce sexual activity in men, if it becomes qualitatively or quantitatively unacceptable for society and / or for themselves, estrogens are prescribed; 1 mg of stilbestrol per day is usually sufficient [see. also antiandrogens ( cyproterone ) and benperidol ]. For nosebleeds, estrogens are prescribed as a last resort for relapses, such as telangiectasia . Atrophic rhinitis and acne may be an indication for the use of estrogens.