Der Internist

, 50:276

Autoimmune Thrombozytopenie, Neutropenie und Hämolyse

Schwerpunkt: Generalisierte und organbezogene Autoimmunerkrankungen

Zusammenfassung

Wenn Antikörper an Thrombozyten, Granulozyten oder Erythrozyten binden, werden diese vermehrt im retikuloendothelialen System abgebaut. Dies kann zur Thrombozytopenie mit Blutungsneigung, Granulozytopenie mit Infektanfälligkeit bzw. zur Anämie führen. Autoimmunhämozytopenien können primär auftreten oder sekundär im Rahmen anderer Grundkrankheiten. Zu diesen gehören Autoimmunerkrankungen, lymphoproliferative Erkrankungen, Immundefekte und virale Infektionen. Die Diagnose wird gesichert durch den Nachweis von Autoantikörpern gegen die betroffenen Blutzellen. Die Indikation für eine Therapie ist vom klinischen Bild und Verlauf abhängig (Blutungsneigung, Infektionen bzw. Anämie). Insbesondere bei der Autoimmunthrombozytopenie sollte die Indikation zur Therapie nicht allein auf Grund der Thrombozytenzahl gestellt werden. Steroide stellen bisher die Basistherapie bei Autoimmunthrombozytopenie und Autoimmunhämolyse dar, während bei Autoimmungranulozytopenien die prophylaktische Gabe von Antibiotika im Vordergrund steht. Wachstumsfaktoren wie Thrombopoietinrezeptoragonisten bei Autoimmunthrombozytopenie und G-CSF bei der Autoimmunneutropenie sowie Anti-CD20-Antikörper stellen neue Therapieoptionen dar.

Schlüsselwörter

Thrombozytopenie Granulozytopenie Hämolyse Autoimmunerkrankung Wachstumsfaktoren 

Autoimmune thrombocytopenia, neutropenia and hemolysis

Abstract

Autoantibodies reduce the life span of platelets, granulocytes, and red blood cells. This may result in thrombocytopenia with bleeding, in neutropenia with infection, and in anemia, respectively. Immune-hemocytopenias can manifest as primary disease without another cause, or they are associated with other underlying morbidities such as autoimmune diseases, lymphoproliferative diseases, immune defects, or viral infections. Diagnosis is confirmed by laboratory tests showing autoantibodies against the respective blood cells. Indication for treatment is the clinical manifestation of symptoms: bleeding in autoimmune thrombocytopenia, infections in neutropenia, and symptomatic anemia, respectively. Especially in case of thrombocytopenia patients should not be treated because of abnormal laboratory values, only. To date steroids are the basic treatment in autoimmune thrombocytopenia and hemolytic anemia, while prophylactic antibiotics are the main treatment in autoimmune neutropenia. Growth factors like the new thrombopoietin receptor agnonists in autoimmune thrombocytopenia or G-CSF in autoimmune neutropenia, and anti-CD20 antibodies are new options for treatment.

Keywords

Thrombocytopenia Neutropenia Hemolysis Autoimmune disease Growth factors 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Institut für Immunologie und Transfusionsmedizin, UniversitätsklinikumErnst-Moritz-Arndt-Universität GreifswaldGreifswaldDeutschland
  2. 2.DRK-Blutspendedienst WestHagenDeutschland
  3. 3.Institut für TransfusionsmedizinCharité – Universitätsmedizin Berlin, Campus Virchow-KlinikumBerlinDeutschland

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