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Dtsch Med Wochenschr 2024; 149(15): 895-903
DOI: 10.1055/a-2277-2059
Review

Differenzialdiagnose und Therapie der Immunthrombozytopenie

Differential diagnosis and therapy of immune thrombocytopenia
Aristoteles Giagounidis
  Klinik für Hämatologie, Onkologie und Palliativmedizin, Marien-Hospital Düsseldorf, Deutschland
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Erratum: Differenzialdiagnose und Therapie der ImmunthrombozytopenieDtsch Med Wochenschr eFirst
DOI: 10.1055/a-2381-4927

Zusammenfassung

Die Immunthrombozytopenie wird durch Autoantikörper gegen Plättchen-Oberflächenantigene ausgelöst. Da der Nachweis von glykoproteinspezifischen Antikörpern nur in etwa der Hälfte der Fälle gelingt, bleibt die ITP eine Ausschlussdiagnose. Neben der EDTA-induzierten Pseudothrombozytopenie müssen insbesondere die sekundäre medikamentöse Thrombozytopenie, eine breite Palette anderer Erkrankungen und hereditäre Thrombozytopenien bedacht werden. In der Therapie der ITP sind Kortikosteroide und Immunglobuline Mittel der Wahl in der Erstlinie. Die Zweitlinie umfasst Thrombopoetin-Rezeptor-Agonisten, Rituximab oder die Splenektomie. Danach kommen der Einsatz von Fostamatinib und nicht steroidaler Immunsuppressiva in Betracht.

Abstract

Immune thrombocytopenia is caused by autoantibodies against surface antigens on platelets. Since only about 50 % of cases will allow the identification of glycoprotein-specific antibodies, ITP remains a diagnosis of exclusion. Apart from EDTA-induced pseudo thrombocytopenia, other diseases like secondary thrombocytopenia due to medication, a large number of other disease and hereditary thrombocytopenias must be taken into account. The first-line therapy of ITP includes corticosteroids and intravenous immunoglobulins. The second line consists of thrombopoietin receptor agonists, rituximab, or splenectomy. For further lines of therapy, Fostamatinib and non-steroidal immunosuppressives are available.

Schlüsselwörter

Differenzialdiagnose - Immunthrombozytopenie - hereditäre Thrombozytopenien - Therapie

Keywords

Differential diagnosis - immune thrombocytopenia - hereditary thrombocytopenias - therapy


Publication History

Article published online:
16 July 2024

© 2024. Thieme. All rights reserved.

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