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

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