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[免疫性血小板减少症的鉴别诊断与治疗]

[Differential diagnosis and therapy of immune thrombocytopenia].

作者信息

Giagounidis Aristoteles

机构信息

Klinik für Hämatologie, Onkologie und Palliativmedizin, Marien-Hospital Düsseldorf, Deutschland.

出版信息

Dtsch Med Wochenschr. 2024 Aug;149(15):895-903. doi: 10.1055/a-2277-2059. Epub 2024 Jul 16.

Abstract

Immune thrombocytopenia is caused by autoantibodies against surface antigens on platelets. Since only about 50 % of cases will allow the identification of glycoprotein-specific antibodies, ITP remains a diagnosis of exclusion. Apart from EDTA-induced pseudo thrombocytopenia, other diseases like secondary thrombocytopenia due to medication, a large number of other disease and hereditary thrombocytopenias must be taken into account. The first-line therapy of ITP includes corticosteroids and intravenous immunoglobulins. The second line consists of thrombopoietin receptor agonists, rituximab, or splenectomy. For further lines of therapy, Fostamatinib and non-steroidal immunosuppressives are available.

摘要

免疫性血小板减少症由针对血小板表面抗原的自身抗体引起。由于只有约50%的病例能够鉴定出糖蛋白特异性抗体,特发性血小板减少性紫癜(ITP)仍然是一种排除性诊断。除了乙二胺四乙酸(EDTA)诱导的假性血小板减少症外,还必须考虑其他疾病,如药物引起的继发性血小板减少症、大量其他疾病和遗传性血小板减少症。ITP的一线治疗包括皮质类固醇和静脉注射免疫球蛋白。二线治疗包括血小板生成素受体激动剂、利妥昔单抗或脾切除术。对于进一步的治疗方案,可使用 fostamatinib 和非甾体类免疫抑制剂。

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