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Strategien zur Behandlung von Thrombozytopenien im Kindesalter

Strategies for treatment of juvenile thrombocytopenia

  • Leitthema
  • Published:
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Zusammenfassung

Hämorrhagische Diathesen durch Thrombozytopenien umfassen verschiedenste Krankheitsentitäten. Genauso vielfältig wie die Ursachen sind die Blutungsmanifestationen. Nach deren Intensität und nach der Grundkrankheit richtet sich die Indikation zur Behandlung und die Wahl der Mittel. Thrombozytentransfusionen sind heute ein unverzichtbarer Bestandteil der Supportivtherapie in der pädiatrischen Onkologie, nach Stammzelltransplantationen und in der pädiatrischen Intensivmedizin. Man weiß heute, dass die immunologisch bedingten Thrombozytopenien zwar phänotypisch gleichförmig verlaufen, jedoch ätiologisch sehr unterschiedlich sind. Dadurch erklärt sich der scheinbare Polypragmatismus und die Vielzahl der Behandlungsmethoden. Es ist ein unerreichtes Ziel, die Therapie ursachengerecht einzusetzen. Fortschritte in der molekularbiologischen Grundlagenforschung von Megakaryopoiese und Thrombozytopoiese lassen – trotz erlebter Rückschläge – hoffen, dass man mit Wachstumsfaktoren oder deren Analoga neue Möglichkeiten zur Behandlung angeborener oder erworbener Störungen der Megakaryopoiese erhält.

Abstract

Haemorrhagic diatheses comprise very different nosological entities. The clinical bleeding patterns are as varied as the underlying causes. Therapy is directed to controlling both. Platelet transfusion is still an indispensible element of supportive care in paediatric oncology, after stem cell transplantation, and in paediatric intensive care. The phenotypes of immunologic thrombocytopenias are similar; however they have very different etiologies. This explains the apparent variety of methods and plethora of different therapeutic modalities. Direct therapy of the causes of the immunologic thrombocytopenias is still an unattained goal. Progress in molecular biologic research of megakaryopoiesis and thrombopoiesis give hope – in spite of setbacks – that specific cytokines or their analogues might offer new approaches for the treatment of inborn or acquired errors of megakaryopoiesis.

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  1. Klinik für Neonatologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin

    C. Dame

  2. Klinik für Allgemeine Pädiatrie des Otto-Heubner-Centrums für Kinder- und Jugendmedizin, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin

    W. Ebell, H. Lode &  G. Gaedicke

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Correspondence to G. Gaedicke.

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Ebell, W., Lode, H., Gaedicke, G. et al. Strategien zur Behandlung von Thrombozytopenien im Kindesalter. Monatsschr Kinderheilkd 154, 540–549 (2006). https://doi.org/10.1007/s00112-006-1350-3

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