Minor bleeding episodes associated with platelet function disorders often do not require medical treatment.
- Small bruises usually disappear on their own.
- Bleeding from minor cuts can be stopped by applying pressure.
However, the treatment of platelet function disorders will depend on the particular type of disorder, as well as the severity of the bleeding.
Most people with a platelet function disorder do not need therapy on a regular basis. However, they do need treatment at the time of surgical procedures including dental surgery following accidental injury.
Dentists and surgeons should be informed that a person has a platelet function disorder so they can plan treatment to prevent bleeding.
Desmopressin
Desmopressin is a synthetic drug which is a copy of a natural hormone. It acts by releasing von Willebrand factor stored in the lining of the blood vessels. The additional von Willebrand factor helps the platelets to stick to the blood vessel wall and clump together at the site of the injury. Desmopressin is not a blood product.
Desmopressin can be taken in three different ways:
- It can be injected into a vein. Most often, the brand name for this kind of desmopressin is DDAVP.
- It can be injected under the skin. The brand name for this kind of desmopressin is often Octostim.
- It can be taken by nasal spray. The brand name of the nasal spray is often Octostim Spray.
The response to Desmopressin varies from person to person. A test of the drug is helpful to determine if Desmopressin treatment is effective in a specific person. If Demopressin does not work, platelet transfusion may be considered.
Desmopressin is an anti-diuretic, that is, it can make the body retain water. Therefore, doctors recommend that, after receiving Desmopressin, people drink only enough fluid to satisfy thirst.
If a person has a very bad headache or has not been able to pass water 24 hours after taking Desmospressin, they should go to their HTC or emergency room for help.
Serious side effects of Desmopressin are very rare but may occur under certain circumstances. Because Desmopressin promotes blood clot formation, there is a small risk of heart attack in older people with coronary artery disease. Water retention can cause changes in the blood salt content, increasing the risk of seizures.
Blood Platelet Transfusion
Some types of platelet function disorders, including Bernard-Soulier Syndrome, Glanzmann Thrombasthenia and abnormalities of procoagulant activity often do not respond to Desmopressin. They may require transfusion of blood platelets for severe bleeding or in preparation for surgery.
antifibrinolytics
Antifibrinolytics – Cyklokapron (tranexamic acid) and Amicar (aminocaproic acid) – are drugs that help to hold a clot in place once it has formed. They act by stopping the activity of an enzyme, called plasmin, which dissolves blood clots.
Cyklokapron and Amicar can be used to hold a clot in place in mucous membranes such as:
- The inside of the mouth
- The inside of the nose
- Inside the intestines (the gut)
- Inside the uterus (the womb).
They are used:
- Before dental work
- When a person has mouth, nose and minor intestinal bleeding
- For women with heavy, prolonged menstrual bleeding.
Because Cyklokapron and Amicar solidify clots but do not actually stop bleeding, they are not usually taken alone. Most often they are taken in combination with Desmopressin or platelet trasfusion. These drugs come in tablet form.
Side effects with Amicar and Cyklokapron are usually mild. They include:
- Feeling like you are going to throw up (nausea)
- Feeling tired or sleepy
- Feeling dizzy
- Having lose bowel movements (diarrhoea)
- Having pain in the stomach
These mild side effects go away when:
- A person stops taking the drugs
- When the doctor reduces the dosage
Birth Control Pills and Hormone Therapy for Menstrual Bleeding
Some women with platelet function disorders have menstrual bleeding which is very heavy and can last longer than normal. This is called menorrhagia. Because the uterus can lose a great deal of blood in a short period of time, and the cycle repeats every month, women can develop iron deficiency anaemia.
Desmopressin or a platelet transfusion may help decrease bleeding for a single episode. Many women control bleeding on a regular basis with the use of birth control pills or another hormone therapy like estrogen.
Treatment for Particular Problems
Nose Bleeds
Repeated nose bleeds can be a serious problem for some people with platelet function disorders. Treatment for a prolonged nose bleed may require the use of Desmopressin or even a platelet transfusion. Cyklokapron and Amicar can be taken to stabilise the blood clot and prevent the bleeding from starting again.
Ointments and creams can be applied to the inside of the nose once bleeding has stopped to prevent drying of the nasal membrane and to promote healing. For mild problems, simple lubricants such as petroleum jelly or propylene glycol (Secaris) can be used. For more severe problems, estrogen cream can be used for short periods of time.
Dental Work
Treatment to control bleeding is necessary if dental work will include a tooth extraction or local anaesthesia (freezing). Desmopressin should be given if the person responds to it.
Cyklokapron and Amicar can decrease bleeding following tooth extraction or dental surgery. These drugs are usually started before the surgery and continued for several days after.
A Mandibular block (freezing of the lower jaw) should not be used unless the platelet function disorder has been corrected by Desmopressin. Such a freezing technique can leas to bleeding in the neck. This could close up the windpipe.
Depending on the specific platelet function disorder, other types of treatment may be recommended.