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Supportive Therapie der Knochenmarksinsuffizienz Technische, immunologische und klinische Entwicklungen

Supportive care in bone marrow failure, — Technical, immunological and clinical advances

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Summary

Supportive care with blood component transfusions has greatly improved prognosis in patients with bone marrow failure. This progress has been made possible by newly developed techniques for separation of blood cells and by a better understanding of the antigenicity of human blood cells and of immunologic reactions following their transfusion. Transfusion of white cell and platelet-poor red cell preparations prevents alloimmunization to leukocyte and platelet-bound alloantigens, or non-hemolytic transfusion reactions in already alloimmunized patients. Alloimmunization can be circumvened and effective long-term platelet support to thrombocytopenic patients can be provided by matching donor and recipient for HL-A antigens. The place of granulocyte transfusions in clinical therapy has yet to be defined, although their usefulness in infected granulocytopenic patients is suggested by the few studies reported so far.

Zusammenfassung

Neben medikamentöser Therapie kommt der supportiven Transfusionstherapie mit Blutzellen in der Behandlung der Knochenmarksinsuffizienz zentrale Bedeutung zu. Neu entwickelte Verfahren zur Separation von Blutzellen und grundlegende Erkenntnisse über deren Antigenizität ermöglichen eine rationell angelegte und therapeutisch effektive Substitution bei Mangelzuständen einzelner Blutzelltypen. Durch Verwendung leukocyten-und thrombocytenarmer Erythrocytenpräparationen werden Alloimmunisierung gegen leukocyten- und thrombocytengebundene Antigene und nicht-hämolytische Transfusionsreaktionen vermieden. Längerwährende effektive Thrombocytensubstitution ist, als Folge der unvermeidlichen Alloimmunisierung, nur mit Thrombocyten HL-A-kompatibler Spender möglich. Die klinische Bedeutung von Granulocytentransfusionen ist derzeit noch nicht endgütlig zu beurteilen, jedoch bestätigen erste Untersuchungen ihre therapeutische Wirksamkeit.

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  1. Abteilung für Hämatologie des Zentrums für Innere Medizin und Kinderheilkunde und Abteilung für Klinische Physiologie des Zentrums für Klinische Grundlagenforschung der Universität Ulm, Germany

    H. -P. Lohrmann, S. F. Goldmann & W. Adam

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  1. H. -P. Lohrmann
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Lohrmann, H.P., Goldmann, S.F. & Adam, W. Supportive Therapie der Knochenmarksinsuffizienz Technische, immunologische und klinische Entwicklungen. Klin Wochenschr 53, 595–603 (1975). https://doi.org/10.1007/BF01469678

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