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Transfusionsmedizin 2015; 5(2): 65-69
DOI: 10.1055/s-0035-1545923
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Refraktärität gegen Thrombozytentransfusionen

Platelet Refractoriness
O. Meyer
Institut für Transfusionsmedizin, Charité – Universitätsmedizin Berlin, Berlin
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Publication History

Publication Date:
26 May 2015 (online)

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Zusammenfassung

Die Transfusion von Thrombozyten hat einen hohen Stellenwert bei der Prophylaxe und Therapie thrombozytär bedingter Blutungen. Allerdings entwickeln bis zu 15 % der Patienten, die regelmäßig Thrombozytentransfusionen benötigen, einen Refraktärzustand, welcher in aller Regel mit einer längeren Behandlungsdauer, höheren Behandlungskosten, einer erhöhten Mortalität sowie einer höheren Rate an Blutungskomplikationen verbunden ist. Überwiegend führen v. a. nichtimmunologische Ursachen zu einer Refraktärität, während immunologische Faktoren, v. a. eine Alloimmunisierung gegen HLA-Klasse-I-Antigene (HLA-A und/oder HLA-B) in weniger als 20 % der Fälle die Ursache darstellen. Können immunologische Gründe für einen Refraktärzustand identifiziert werden, so sollten möglichst HLA-A/B-idente Thrombozytenkonzentrate transfundiert werden. Stehen solche Präparate nicht zur Verfügung, können ein Epitop-Matching, das Vermeiden der Antigene, gegen die eine Alloimmunisierung vorliegt, oder ein Crossmatch zur Auswahl kompatibler Thrombozytenpräparate erwogen werden. Patienten, bei denen es trotz dieser Maßnahmen nicht zu einem befriedigenden Transfusionserfolg kommt oder bei denen keine immunologische Ursache identifiziert wurde, sollten höhere Dosen an Thrombozyten erhalten. Unspezifische Maßnahmen wie eine Hemmung der Fibrinolyse mit Tranexamsäure oder die Gabe von rekombinantem Faktor VII a (rFVIIa) bei schweren Blutungen können u. U. unterstützend eingesetzt werden.

Abstract

Platelet transfusions are important in order to prevent or to control active bleeding. However, up to 15 % of patients that require regular platelet transfusions develop platelet refractoriness, which is linked to prolonged treatment duration, higher costs, higher mortality, and a higher rate of bleeding complications. The vast majority of platelet refractoriness is related to non-immune factors, whereas immunological factors, especially HLA-alloimmunization (HLA-A and/or HLA-B) affect less than 20 % of cases. Immunized patients should receive HLA-A/B identical platelets. If such platelets are not available, epitope matching or in vitro crossmatching may be applied alternatively. Immunized patients that do not adequately respond to such selected platelets or patients with solely non-immunological reasons should receive higher platelet doses. Unspecific medications like tranexamic acid or recombinant factor VII a (rFVIIa) in cases of severe bleeding may be used as appropriate.

Schlüsselwörter

Thrombozyten - Thrombozytentransfusion - Refraktärität - Alloimmunisierung - Management

Key words

platelet - platelet transfusion - platelet refractoriness - alloimmunization - management
 

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