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Hamostaseologie 1992; 12(03): 107-115
DOI: 10.1055/s-0038-1660325
Übersichtsarbeit/Review Articles
Schattauer GmbH

Thrombosen bei Kindern mit akuter lymphatischer Leukämie

unter besonderer Berücksichtigung der Asparaginase-Therapie
A. H. Sutor
1   Universitätsklinik Freiburg
,
J. Ritter
2   Zentrum für Kinderheilkunde Münster
› Author Affiliations
Further Information

Publication History

Publication Date:
26 June 2018 (online)

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Zusammenfassung

Während der Behandlung der akuten lymphatischen Leukämie im Kindesalter kommen Blutungs- und/oder Thrombosekomplikationen in einer Häufigkeit von 1-3% vor. Veränderungen von Gerinnungsparametern treten bei fast allen Patienten auf, wofür Glukokortikoide (GC) und Coli-Asparaginase (Coli-ASP) verantwortlich sind. Während GC zum graduellen Abfall von Fibrinogen und graduellen Anstieg von AT III und Protein C führen, kommt es unter Coli-ASP zum schnellen Abfall von Plasminogen, AT III und Protein C und zum weiteren Abfall von Fibrinogen. Die Resultante aus den unterschiedlichen Alterationen ist im einzelnen nicht vorhersehbar. Diese Veränderungen normalisieren sich nach Absetzen von GC und Coli-ASP. Blutungs- und/oder Thrombosekomplikationen sind selten. Sie werden u.a. während der gemeinsamen GC-Coli-ASP-Behandlungsphase beobachtet und scheinen nach einer gemeinsamen Therapiedauer von 2-3 Wochen gehäuft vorzukommen. Unter Erwinia-Asparaginase wurden die Gerinnungsveränderungen nicht beobachtet.

Als prophylaktische Maßnahme sollte die Entkoppelung von GC und Coli-ASP diskutiert werden sowie der Ersatz von Coli-ASP durch Erwinia-ASP. Die Wirksamkeit einer Substitution der abgefallenen anti- oder prokoagulatorischen Hämostasefaktoren ist nicht erwiesen.

Schlüsselwörter

Thrombose - akute lymphatische Leukämie - Kindesalter - Asparaginase - Kortikosteroide

Key words

Thrombosis - acute lymphoblastic leukemia - childhood - asparaginase - corticosteroids
 

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