Kneitz C, Atta J, Burkhardt H
Klinik für Innere Medizin II (Rheumatologie und Klinische Immunologie, Geriatrie), Klinikum Südstadt Rostock, Am Südring 91, 18059, Rostock, Deutschland.
Tumortherapie-Center, Prof. Dr. Stehling Institut für bildgebende Diagnostik, Strahlenbergerstr. 110 - AlphaHaus, 63067, Offenbach am Main, Deutschland.
Z Rheumatol. 2017 Oct;76(Suppl 2):63-74. doi: 10.1007/s00393-017-0364-7.
Hematological alterations can often be observed during rheumatic diseases. The effects can be clinically severe, ranging from anemia of different grades of severity, through increased risk of hemorrhage due to thrombocytopenia up to severe infections as a result of high-grade leukocytopenia. The clinical sequelae for patients are predominantly determined by the extent of cytopenia. The underlying disease itself can initially be considered as the cause. Examples are anemia as a result of chronic inflammation, antibody-mediated thrombocytopenia as in systemic lupus erythematosus (SLE) or granulocytopenia within the framework of Felty's syndrome. Immunosuppressive treatment also often leads to alterations in the blood constituents. Although some substances, such as cyclophosphamide can suppress all three cell types, there are also selective effects, such as isolated thrombocytopenia under treatment with tocilizumab and JAK inhibitors. The differential diagnostic clarification of cytopenia can be difficult and necessitates a systematic work-up of the course of the disease and the subsequent treatment. The reviews of anemia, leukocytopenia and thrombocytopenia presented here summarize the most important components of the differentiation of hematological alterations in patients with rheumatic diseases.
在风湿性疾病过程中,常常可以观察到血液学改变。这些影响在临床上可能很严重,从不同严重程度的贫血,到因血小板减少导致出血风险增加,直至因重度白细胞减少引发严重感染。患者的临床后遗症主要取决于血细胞减少的程度。潜在疾病本身最初可被视为病因。例如,慢性炎症导致的贫血、系统性红斑狼疮(SLE)中抗体介导的血小板减少或费尔蒂综合征框架内的粒细胞减少。免疫抑制治疗也常常导致血液成分的改变。虽然某些物质,如环磷酰胺可抑制所有三种细胞类型,但也有选择性作用,如使用托珠单抗和JAK抑制剂治疗时出现的孤立性血小板减少。血细胞减少的鉴别诊断可能很困难,需要对疾病进程及后续治疗进行系统检查。本文对贫血、白细胞减少和血小板减少的综述总结了风湿性疾病患者血液学改变鉴别诊断的最重要组成部分。