Abklärung erhöhter Blutungsneigung – Schritt für Schritt

Das Leitsymptom der hämorrhagischen Diathese ist die Blutungsneigung, deren Ausprägung maßgeblich von der zugrunde liegenden Hämostasestörung beeinflusst wird. Unterteilt werden kann in thrombozytäre, plasmatische und vaskuläre Ursachen. Zentraler Bestandteil der Diagnostik ist neben der individuellen Blutungs- und Familienanamnese die differenzierte Labordiagnostik.

Abstract

The main symptom of hemorrhagic diathesis is an increased bleeding tendency. Due to the subjectivity of various features of the bleeding history, unclarity of the family history, and an individualization of the extent of diagnostic the evaluation of a suspected bleeding disorder represents a challenging endeavour in hematology. Hemorrhagic diathesis can be divided into the following sub-categories: disorders in primary hemostasis (e. g. von Willebrand disease, different causes of thrombocytopenia), secondary hemostasis (e. g. hemophilia A and B, Vitamin K deficiency) and fibrinolysis, and in connective tissue or vascular formation. This article reviews available diagnostic methods for bleeding disorders, from structured patient history to highly specialized laboratory diagnosis.

Schlüsselwörter

Blutungsstörung - Hämostase - Blutgerinnungsstörungen - Diagnose

Key words

bleeding disorder - hemostasis - blood coagulation disorders - diagnosis

Publication History

Article published online:
13 October 2021

• Literatur

• 1 Luxembourg B, Krause M, Lindhoff-Last E. Basiswissen Gerinnungslabor. Dtsch Arztebl International 2007; 104: 1489-1498
• 2 Alban S, Bergmann F, Czwalinna A. et al. Das Gerinnungskompendium. In: Hrsg, Barthels M. Schnellorientierung, Befundinterpretation, klinische Konsequenzen. 2 Aufl.. Stuttgart: Georg Thieme Verlag; 2012
• 3 Girolami A, Luzzatto G, Varvarikis C. et al. Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking. Haemophilia 2005; 11: 193-202 DOI: 10.1111/j.1365-2516.2005.01100.x.
• 4 Koscielny J, von Tempelhoff GF, Ziemer S. et al. A practical concept for preoperative management of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 2004; 10: 155-166 DOI: 10.1177/107602960401000206.
• 5 Rodeghiero F, Tosetto A, Abshire T. et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost 2010; 8: 2063-2065 DOI: 10.1111/j.1538-7836.2010.03975.x.
• 6 Koscielny J, Ziemer S, Radtke H. et al. A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 2004; 10: 195-204 DOI: 10.1177/107602960401000301.
• 7 Spannagl M, Moessmer G. [Global tests of haemostasis]. Hamostaseologie 2006; 26: 27-37
• 8 Streif W, Knöfler R. Diagnose von Thrombozytenfunktionsstörungen – Thrombozytopathien; Version 2.1. Stand 2018. AWMF-Register Nr. 086-003. Im Internet (Stand: 07.08.2021): https://www.awmf.org/leitlinien/detail/ll/086-003.html
• 9 Jackson CM, White 2nd GC, Barrowcliffe T. et al. A reference system approach to future standardization of laboratory tests for hemostasis. A position paper of the Joint Committee of the IFCC Scientific Division and the ISTH Scientific and Standardization Committee. Thromb Haemost 2002; 87: 165-169
• 10 Lillicrap D, Nair SC, Srivastava A. et al. Laboratory issues in bleeding disorders. Haemophilia 2006; 12 (03) 68-75 DOI: 10.1111/j.1365-2516.2006.01279.x.
• 11 De Robertis E, Kozek-Langenecker SA, Tufano R. et al. Coagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding. Minerva Anestesiol 2015; 81: 65-75