Update 2021: COVID-19 aus Sicht der Hämatologie und Hämostaseologie

Die Infektion mit SARS-CoV-2 hat einen weitreichenden Einfluss auf das hämatopoetische System, das klinische Symptome und Mortalität vermittelt. Dieser Beitrag befasst sich mit dem Zytokinsturm bei COVID-19, der COVID-assoziierten Koagulopathie (CAC) und der impfstoffinduzierten immunthrombotischen Thrombozytopenie (VITT). Darüber hinaus wird der aktuelle Stand zur Therapie mit Rekonvaleszentenplasma (RKP) dargestellt.

Abstract

Infection with SARS-CoV-2 has a profound influence on the hematopoetic system that mediates clinical symptoms and mortality. Several studies have shown that treatment of the cytokine storm (CRS) with anti-inflammatory drugs like dexamethasone and tocilizumab can significantly improve survival. Systematic reviews confirm the safety of convalescent plasma administration and offer initial indications of its effectiveness in certain groups. COVID-associated coagulopathy (CAC) and vaccine-induced immune thrombotic thrombocytopenia (VITT) represent severe infection- or vaccination associated complications that require a specific diagnostic and therapeutic workup.

Schlüsselwörter

Coronavirus-Infektion - Komplikationen - Therapie - hämatologische Erkrankungen - Entzündung - hämostaseologische Komplikationen - Rekonvaleszenzplasma

Key words

coronavirus infections - complications - therapy - hematologic Diseases - inflammation - haemostatic complications - reconvalescent plasma

Publication History

Article published online:
13 July 2021

• Literatur

• 1 Giamarellos-Bourboulis EJ, Netea MG, Rovina N. et al. Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure. Cell Host Microbe 2020;
• 2 Shimabukuro-Vornhagen A, Gödel P, Subklewe M. et al. Cytokine release syndrome. J Immunother Cancer 2018; 6: 56
• 3 Gordon AC, Mouncey PR, Al-Beidh F. et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med 2021; 384: 1491-1502
• 4 Horby P, Lim WS, Emberson JR. et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med 2021; 384: 693-704
• 5 What’s new. COVID-19 Treatment Guidelines. https://www.covid19treatmentguidelines.nih.gov/whats-new/ ; Stand: 12.05.2021
• 6 Iba T, Warkentin TE, Thachil J. et al. Proposal of the Definition for COVID-19-Associated Coagulopathy. J Clin Med 2021; 10
• 7 Langer F, Kluge S, Klamroth R. et al. Coagulopathy in COVID-19 and Its Implication for Safe and Efficacious Thromboprophylaxis. Hamostaseologie 2020; 40: 264-269
• 8 Greinacher A, Thiele T, Warkentin TE. et al. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med 2021;
• 9 Oldenburg J, Klamroth R, Langer F. et al. Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH. Hamostaseologie 2021;
• 10 Barreira DF, Lourenço RA, Calisto R. et al. Assessment of the Safety and Therapeutic Benefits of Convalescent Plasma in COVID-19 Treatment: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8: 660688
• 11 Joyner MJ, Bruno KA, Klassen SA. et al. Safety Update: COVID-19 Convalescent Plasma in 20,000 Hospitalized Patients. Mayo Clin Proc 2020; 95: 1888-1897
• 12 Kluge S, Janssens U, Welte T. et al S3-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19 (17.05.2021). AWMF-Register-Nr. 113/001. https://www.awmf.org/uploads/tx_szleitlinien/113-001LGl_S3_Empfehlungen-zur-stationaeren-Therapie-von-Patienten-mit-COVID-19__2021-05.pdf ; Stand: 10.06.2021