Rationale Indikationsstellung zur Thrombozytenkonzentrat-Transfusion

Zusammenfassung

Bisher wird routinemäßig bei akuter hypoproliferativer Thrombozytopenie eine prophylaktische Thrombozytentransfusion empfohlen. Bei chronischer Thrombozytopenie wurde schon länger ein restriktiveres Vorgehen im Sinne einer vorwiegend therapeutischen Transfusionsstrategie vorgeschlagen. In Deutschland werden aktuell jährlich eine halbe Million Thrombozytentransfusionen verabreicht mit weiter steigender Tendenz. Die weitaus meisten Thrombozytentransfusionen werden bei hämatologischen und onkologischen Patienten verbraucht. Untersuchungen besagen, dass die Hämotherapie-Leitlinien nicht überall und nicht konsequent eingehalten werden. Neue Studien weisen auf die Möglichkeit einer therapeutischen Transfusionsstrategie für klinisch stabile Patienten hin, die ein niedriges Blutungsrisiko haben wie z. B. nach autologer hämatopoetischer Blutstammzelltransplantation. Patienten mit hohem Blutungsrisiko wie z. B. bei akuter Leukämie sollen unverändert außerhalb von Studien prophylaktisch transfundiert werden. Dabei hat sich die Transfusion ab einem Thrombozytengrenzwert von 10 000/µL ohne Einschränkung als sicher erwiesen, solange keine Blutungszeichen vorliegen. Insgesamt ließe sich durch eine rationale Indikationsstellung der Verbrauch an Thrombozytenkonzentraten deutlich senken. Der morgendlich gemessene Thrombozytenwert allein lässt bei thrombozytopenischen Patienten das Risiko für klinisch relevante Blutungen nicht vorhersagen. Das Risiko wird wesentlich durch die klinischen Faktoren des Patienten bestimmt. Um schwerwiegende Blutungen zu vermeiden, ist es wichtig, auf erste Zeichen von Blutungen zu achten und nicht allein auf den morgendlichen Thrombozytenwert. Eine entsprechende Schulung der Patienten und des medizinischen Personals ist dafür erforderlich.

Abstract

To date, routine prophylactic platelet transfusion is recommended in acute hypoproliferative thrombocytopenia. In chronic thrombocytopenia a more restrictive strategy has been proposed since many years that leads mainly to a therapeutic transfusion strategy. In Germany, to date, half a million of platelet transfusions per year have been performed. By far, most platelet transfusions are used in haematology and oncology patients. Studies have shown that hematotherapy guidelines are not followed strictly enough in many hospitals. According to recent trials clinically stable patients who are at low risk for bleeding – e.g. patients who have undergone autologous hematopoietic stem cell transplantation – can be treated by a therapeutic transfusion strategy. Patients with a high bleeding risk as e.g. with acute leukaemia should still receive a prophylactic transfusion. In patients without bleeding signs a transfusion trigger of 10 000/µL without any modification has been proven to be safe. In conclusion, the number of platelet transfusions could be lowered significantly if a rational strategy of transfusion would be followed. The risk of clinically relevant bleeding in thrombocytopenic patients can not be predicted exclusively by the morning platelet count. This risk is mainly due to clinical factors of the patient. Taking care of first signs of hemorrhage is important to avoid severe bleeding and not only the morning platelet count. Appropriate training of patients and medical staff is required.

Schlüsselwörter

Thrombozytentransfusion - Thrombozytopenie - Blutungsrisiko - prophylaktische und therapeutische Thrombozytentransfusion - Bedarf nach Thrombozytentransfusion

Key words

platelet transfusion - thrombocytopenia - bleeding risk - prophylactic and therapeutic platelet transfusion - demand of platelet transfusion

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