Rationale Therapie mit Thrombozytenkonzentraten

Thrombozytenkonzentrate (TK) stellen eine der wichtigsten Therapieoptionen bei der Aufrechterhaltung der Hämostase bei Thrombozytopenien und Thrombozytenfunktionsdefekten dar. Ihre Herstellung und Anwendung ist in Deutschland durch die „Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten“ [1] und die „Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten“ [2] geregelt. In diesem Übersichtartikel werden die wichtigsten praktischen Aspekte der Therapie mit TKs zusammengefasst.

Abstract

Platelet concentrates are one of the most important therapy options in the treatment of hemostaseological diseases. Their production and use in Germany is regulated by the national guidelines „Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten“ and „Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten“. This article aims to give an overview of essential practical aspects in the production and therapy with platelet concentrates.

Platelet concentrates can be manufactured either from buffy coat or by apheresis. Both methods have different advantages and disadvantages but seem to be equal from a clinical point of view. rhesus-compatible transfusion of platelets is particularly important in girls and women of childbearing age. In case of rhesus-incompatible transfusion, a rhesus prophylaxis could be indicated in this patient population. Patients who have developed antibodies to human leukocyte antigen (HLA) or human platelet antigen (HPA) should be treated with HLA-/HPA-compatible apheresis platelet concentrates. HLA-/HPA-combability should be considered superior to AB0- and rhesus-compatibility.

Prophylactic platelet transfusion is usually recommended for a platelet count<10000/µl in in hematologic patients. Lower platelet counts can be tolerated in patients with chronic thrombocytopenia. The need for prophylactic platelet transfusion before interventional or surgical procedures depends largely on the type of procedure. Recommendations range from no prophylactic transfusion (e. g., bone marrow biopsy) to platelet thresholds>100000/µl before operations with a high bleeding risk (e. g., intracranial surgery). A platelet transfusion threshold of 50000–100000/µl is recommended in acute bleeding situations.

Schlüsselwörter

Thrombozytenkonzentrate - Transfusion - Prophylaktisch - Therapeutisch - Indikation

Key words

platelet transfusion - guidelines - prophylactic transfusion - therapeutic transfusion - thrombocyte tresholds

Publication History

Article published online:
21 February 2023

• Literatur

• 1 Bundesärztekammer. Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Richtlinie Hämotherapie). (2021) Im Internet: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/RL/RiliH_Lese.pdf(Stand: 29.12.2022)
• 2 Bundesärztekammer. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. (2020) Im Internet: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/MuE/Querschnitts-Leitlinien_BAEK_zur_Therapie_mit_Blutkomponenten_und_Plasmaderivaten-Gesamtnovelle_2020.pdf(Stand: 29.12.2022)
• 3 Moncharmont P, Barday G, Meyer F. Red blood cell alloimmunisation after platelet transfusion: a 5-year study. Blood Transfus 2014; 12: s147-s148
• 4 Bowden RA, Slichter SJ, Sayers M. et al. A comparison of filtered leukocyte-reduced and cytomegalovirus (CMV) seronegative blood products for the prevention of transfusion-associated CMV infection after marrow transplant. Blood 1995; 86: 3598-3603
• 5 Slichter SJ, Davis K, Enright H. et al. Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood 2005; 105: 4106-4114
• 6 Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol 2008; 142: 348-360
• 7 Murphy MF, Waters AH. Immunological aspects of platelet transfusions. Br J Haematol 1985; 60: 409-414
• 8 Schnaidt M, Northoff H, Wernet D. Frequency and specificity of platelet-specific alloantibodies in HLA-immunized haematologic-oncologic patients. Transfus Med 1996; 6: 111-114
• 9 Petz LD, Garratty G, Calhoun L. et al. Selecting donors of platelets for refractory patients on the basis of HLA antibody specificity. Transfusion 2000; 40: 1446-1456
• 10 Lee RH, Kasthuri RS, Bergmeier W. Platelet transfusion for patients with platelet dysfunction: effectiveness, mechanisms, and unanswered questions. Current Opinion in Hematology 2020; 27: 378-385
• 11 Estcourt LJ, Birchall J, Allard S. et al. Guidelines for the use of platelet transfusions. Br J Haematol 2017; 176: 365-394
• 12 Kaufman RM, Djulbegovic B, Gernsheimer T. et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2015; 162: 205-213
• 13 Nahirniak S, Slichter SJ, Tanael S. et al. Guidance on platelet transfusion for patients with hypoproliferative thrombocytopenia. Transfus Med Rev 2015; 29: 3-13
• 14 Schiffer CA, Bohlke K, Delaney M. et al. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2018; 36: 283-299
• 15 Wandt H, Schäfer-Eckart K, Greinacher A. Platelet transfusion in hematology, oncology and surgery. Dtsch Arztebl Int 2014; 111: 809-815
• 16 Malouf R, Ashraf A, Hadjinicolaou AV. et al. Comparison of a therapeutic-only versus prophylactic platelet transfusion policy for people with congenital or acquired bone marrow failure disorders. Cochrane Database Syst Rev 2018; 5: CD012342
• 17 Leemann H, Lustenberger T, Talving P et al. The role of rotation thromboelastometry in early prediction of massive transfusion. J Trauma 2010; 69: 1403–1408; discussion 1408–1409. doi: 10.1097/TA.0b013e3181faaa25
• 18 Curley A, Stanworth SJ, Willoughby K. et al. Randomized Trial of Platelet-Transfusion Thresholds in Neonates. NEJM 2018; 380: 242-251
• 19 Delaney M, Wendel S, Bercovitz RS. et al. Transfusion reactions: prevention, diagnosis, and treatment. Lancet 2016; 388: 2825-2836
• 20 Paul-Ehrlich-Institut. Bericht des Paul-Ehrlich-Instituts über die nach § 21 Transfusionsgesetz gemeldeten Daten 2020. (2021) Im Internet: https://www.pei.de/SharedDocs/Downloads/DE/regulation/meldung/21-tfg/21-tfg-berichte/2020-tfg-21-bericht.pdf?__blob=publicationFile&v=4#:~:text=Im%20Jahr%202020%20haben%20180,an%20das%20PEI%20(96%20%25 (Stand: 29.12.2022)
• 21 Paul-Ehrlich-Institut. Hämovigilanzbericht der Paul-Ehrlich-Instituts 2016/2017. (2018) Im Internet: https://www.pei.de/SharedDocs/Downloads/DE/newsroom/pflichtberichte/haemovigilanzberichte/haemovigilanz-bericht-2016-2017.pdf?__blob=publicationFile&v=2 (Stand: 29.12.2022)