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Mikroangiopathische hämolytische Anämie bei malignen Tumorerkrankungen

Microangiopathic hemolytic anemia in metastatic carcinoma

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Summary

Clinical features and the pathophysiological mechanisms leading to red cell fragmentation and thrombocytopenia of microangiopathic hemolytic anemia in metastatic carcinomas are discussed in this review. Experimental data, clinical and post mortem findings strongly suggest that the development of stable intravascular fibrin thrombi during disseminated intravascular coagulation precedes and causes mechanical hemolysis. The diagnostic hallmark are the red cell fragments (schistocytes) in blood smears. Usually a late and fatal complication of metastatic carcinoma, microangiopathic hemolytic anemia may be the presenting sign of the underlying disease or may indicate the development of metastatic disease in a previously diagnosed tumor. Intensive combination chemotherapy supplemented by optimal blood component transfusion support represents the best therapeutic means to interrupt hemolysis and thrombocytopenia.

Zusammenfassung

Klinische Befunde der bei metastasierenden Carcinomen gelegentlich auftretenden mikroangiopathischen hämolytischen Anämie werden besprochen und pathophysiologische Zusammenhänge dargestellt. Gesteigerte intravasale Gerinnung, die klinisch häufig nur schwer zu erfassen ist, führt zur Entstehung stabiler Fibrinpräcipitate in der Endstrombahn. Experimentelle, klinische und pathologischanatomische Beobachtungen weisen darauf hin, daß die Hämolyse durch mechanische Erythrocytenfragmentation an derartigen intravasalen Fibringerinnseln zustandc kommt. Diagnostisch wegweisend sind die im Blutausstrich auftretenden Erythrocytenfragmente (Schistocyten). Eine mikroangiopathische hämolytische Anämie ist eine akut einsetzende, prognostisch ungünstige Komplikation fortgeschrittener Tumorerkrankungen; sie stellt jedoch nicht selten erstes Symptom eines Tumorleidens dar. Therapeutische Maßnahmen sind begrenzt: Neben supportiver Transfusionstherapie bietet aggressive Chemotherapie die besten Aussichten, die Hämolyseintensität und Thrombocytopenie zu beeinflussen.

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    Hans-Peter Lohrmann

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Lohrmann, HP. Mikroangiopathische hämolytische Anämie bei malignen Tumorerkrankungen. Klin Wochenschr 52, 1143–1150 (1974). https://doi.org/10.1007/BF01466732

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