Der Gynäkologe

, Volume 41, Issue 8, pp 597–602

Supportive Therapie mit Blut und Blutkomponenten

Anämie und Thrombozytopenie
Leitthema
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Zusammenfassung

Die Anämie ist eine der häufigsten Nebendiagnosen in der Onkologie. Für die Patientin steht im Rahmen der Anämiesymptomatik das Fatigue-Syndrom mit der damit einhergehenden Verminderung der Lebensqualität im Vordergrund. Therapeutisch verfügbar sind Erythrozytenkonzentrate (EK) und Erythropoese-stimulierende Faktoren („erythropoesis stimulating agents“, ESA). Erstere sind mit höherem logistischem Aufwand und dem Risiko für Transfusionsreaktionen wie Infektionen verbunden, gewährleisten aber einen schnellen Hämoglobinanstieg. Der Einsatz von ESA erreicht in den meisten Fällen einen stabilen Hämoglobinanstieg. Allerdings gibt es zunehmend Bedenken bezüglich der Sicherheit in der onkologischen Anwendung. Thrombozytopenien sind eine häufige Erscheinung bei Knochenmarksinfiltration und/oder intensiver Chemotherapie. Prophylaktisch sollten Thrombozytenkonzentrate (TK) bei Thrombozyten <10.000 plts/μL eingesetzt werden. Auch bei einer Blutungsneigung von ≥WHO-Grad 2 werden Thrombozytentransfusionen empfohlen. Die Transfusion von Thrombozyten birgt ähnliche Risiken wie die von Erythrozyten. Refraktärzustände können nichtimmunologische wie immunologische Hintergründe haben. Bei Letzteren wird eine differenzierte Spendersuche notwendig.

Schlüsselwörter

Anämie Thrombozytopenie Erythropoese-stimulierende Faktoren Onkologie Erythropoetine Supportivtherapie 

Supportive therapy with blood and blood components

Anaemia and thrombocytopenia

Abstract

Anaemia is one of the most common secondary diagnoses in oncology. The accompanying fatigue syndrome is the leading symptom reducing quality of life. Therapeutic options include transfusion of erythrocyte concentrates and the use of erythropoiesis stimulating agents (ESA). The former is logistically more involved and carries the risk of infection and reaction to the transfusions, but it guarantees rapid haemoglobin increase. The ESA allow stable haemoglobin increase in most cases, but doubt is increasing about their safety in an oncological setting. Thrombocytopenias are a frequent occurrence with bone marrow infiltration and/or intensive chemotherapy in cancer patients. In case of a WHO grade 2 anticoagulatory tendency, thrombocyte transfusions are recommended. The risks are similar to those with erythrocytes. Refractory conditions can have either immunologic or nonimmunologic etiology. In case of the former, a dfferentiated search for donors is required.

Keywords

Anaemia Thrombocytopenia Erythropoiesis stimulating agents Oncology Erythropoietin Supportive care 

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Universitäts-Frauenklinik RostockRostockDeutschland

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