Erworbene Plättchenfunktionsstörungen

Zusammenfassung

Angesichts des hohen Medikamentenkonsums in unserer Gesellschaft überrascht es nicht, dass Pharmaka die Hauptursache erworbener Plättchenfunktionsstörungen darstellen. Neben den typischen Vertretern antithrombozytärer Medikamente wie Azetylsalizylsäure, Clopidogrel und ╒IIb®3 (GPIIb-IIIa)-Rezeptorantagonisten können auch andere häufig eingesetzte Medikamente wie nicht steroidale entzündungshemmende Substanzen, Antibiotika, Serotonin- Wiederaufnahme-Inhibitoren und Volumenexpander die Plättchenfunktion beeinträchtigen und eine Blutungsneigung bedingen oder verstärken. Daneben gibt es klinische Zustände, die mit Plättchenfunktionsstörungen einhergehen und eine hämorrhagische Diathese verursachen. Im Gegensatz zu angeborenen Thrombozytopathien treffen wir im klinischen Alltag sehr viel häufiger auf erworbene Plättchenfunktionsstörungen. Sie verdienen besondere Aufmerksamkeit. Ihre Pathogenese ist weitgestreut und reichlich heterogen. Die genaue Diagnostik kann schwierig sein, da manchmal überlappende Abweichungen bei der gleichen Krankheit bestehen. Darüber hinaus können erworbene Plättchenfunktionsstörungen in jedem Lebensalter auftreten und in ihrem Schweregrad von gering bis lebensbedrohlich reichen. Angesichts ihrer Heterogenität werden die erworbenen Thrombozytopathien im Zusammenhang mit der klinischen Situation bzw. Grunderkrankung besprochen.

Summary

Given the high consumption of pharmacological agents in western societies, it is not surprising at all that drugs represent the most common cause of acquired platelet dysfunction. While acetylsalicylic acid, clopigogrel and integrin ╒IIb®3 (GPIIb-IIIa) receptor antagonists are well-known as prototypes of antiplatelet drugs, other widely used agents including non-steroidal anti-inflammatory drugs, antibiotics, serotonin reuptake inhibitors, and volume expanders can also impair platelet function and cause or aggravate haemorrhages. Besides pharmacological agents, certain clinical conditions are often associated with qualitative platelet disorders and bleeding diathesis. Consequently, in contrast to inherited platelet disorders, acquired platelet function defects are much more frequent in clinical practice and deserve special attention. Their patho genesis is widespread and heterogeneous with various, sometimes overlapping abnormalities. Moreover, acquired platelet dysfunctions can occur at any age and range in severity from mild to life-threatening haemorrhages. Due to their heterogeneity, acquired platelet function disorders will be classified and discussed according to the underlying clinical setting or disease.

Schlüsselwörter

Plättchenfunktionsstörungen - antithrombozytäre Substanzen - Niereninsuffizienz - Leberzirrhose - akute Leukämien - myelodysplastische Syndrome - myeloproliferative Erkrankungen - Myelome

Keywords

Platelet dysfunction - antiplatelet drugs - renal failure - liver cirrhosis - acute leukaemias - myelodysplastic syndromes - myeloproliferative disorders - myelomas

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