Therapy of platelet diseases

A thrombocyte deficiency of less than 50,000 platelets per microlitre of blood is dangerous in most cases and should be treated. Depending on the cause of the deficiency, a number of treatment methods are available. In cases of pure platelet loss after heavy bleeding, for example after a traffic accident, platelet concentrates are suitable.

These are given to the patient intravenously, i.e. by means of a needle into a vein. Platelet concentrates are obtained from donors in blood banks or blood donation facilities. In some cases it is necessary to find several donors for one patient, because on the one hand the amount of donations and the intervals between donations are limited, on the other hand some patients (mostly leukemia patients) need large amounts of platelets.

The target value is 150,000 platelets per microliter upwards. For operations, it is necessary to raise the platelet count to over 50,000 and possibly even higher, as it becomes extremely difficult for the surgeon to stop any bleeding during the operation – after all, blood does not clot without platelets. On the other hand, in many cases, coagulation can also be disruptive: For example, if the patient has an increased risk of his or her blood vessels closing.

It must be remembered that the body reacts to anything in a blood vessel that it feels does not belong there with a platelet reaction. This means among other things: an artificial heart valve, arteriosclerosis, a metal insert like a stent, any deposit of fat, damage to the inner wall of the vessel, etc. Here there is a risk of a blood clot forming, and its detachment and migration into smaller vessels, such as the brain, lungs or heart, which would lead to infarcts.

In order to prevent this clotting, there is the very well-known group of antiplatelets. This means in English that these drugs prevent the aggregation of blood platelets. The most famous representative is probably acetylsalicylic acid, ASS for short, the best-known trade name “Aspirin“.

This drug is able to keep the blood fluid and prevent it from attaching to supposed foreign bodies in the vessel. It is used in patients with high blood pressure, arteriosclerosis and a general risk of thrombosis due to prolonged lying (in hospital) or sitting (on planes, on bus trips). Other known drugs with similar effects, but different starting points are clopidogrel or abciximab.

Prevention

For most people, the platelet count is within the normal range and does not require therapy. An artificial correction of the platelet count may be necessary in risk patients such as long-term smokers, obese patients, or those with high cholesterol levels. In most cases, an antiplatelet aggregation inhibitor such as ASA is given prophylactically in individually dependent dosages.

This keeps the blood fluid, prevents the formation of a clot and the risk of thrombosis. A well-known non-drug measure is the use of thrombosis stockings, which compress the legs. This increases the pressure on the vessels, accelerates the blood flow and prevents blood stagnation. In order to prevent this from happening in the first place, a healthy diet, sufficient physical activity for 2-3 hours per week and abstention from risk factors such as cigarettes and alcohol are essential.