Trombocitopenija pri bolniku z rakom

Povzetek

Trombocitopenija je zmanjšanje števila trombocitov v periferni krvi pod normalno število, definirano za populacijo. Nedvoumne opredelitve za blago, zmerno ali hudo trombocitopenijo ni, stopnje trombocitopenije pa so opisane pri bolnikih z rakom, ki prejemajo sistemsko zdravljenje. Posledica trombocitopenije so krvavitve, najpogosteje v kožo in sluznice, redkeje v osrednje živčevje. Trombocitopenija nastane zaradi zmanjšanega nastajanja trombocitov, zaradi povečanega propadanja ali porabljanja trombocitov ter zaradi povečanega zadrževanja trombocitov v vranici. Pri bolniku z rakom je glavni vzrok zanjo zavora razraščanja in dozorevanja megakariocitov ob citostatskem zdravljenju, redkeje ob obsevalnem zdravljenju. Možni so tudi drugi vzroki, npr. obsežna infiltracija kostnega mozga z malignimi celicami, hipersplenizem ob povečani vranici, povečano propadanje trombocitov pri trombocitopeniji po zdravilih (heparin), pri kroničnih levkemijah in limfomih, v sklopu diseminirane intravaskularne koagulacije in sepse. Pri hudi trombocitopeniji (< 10 x 109 /l) se močno poveča tveganje za spontane krvavitve v kožo in sluznice ter tveganje za spontane intrakranialne krvavitve. Pri teh bolnikih se pojavljajo tudi čezmerne krvavitve po kirurških posegih. Diagnozo trombocitopenije postavimo na podlagi popolne krvne slike. Na tej podlagi določimo tudi njeno stopnjo. Za opredelitev vzroka so pomembni natančna anamneza, usmerjen klinični pregled in dodatne laboratorijske preiskave. Pogosto je potrebna tudi aspiracija/biopsija kostnega mozga. Krvavitve zdravimo ali preprečujemo z nadomeščanjem trombocitov. Število, pri katerem začnemo nadomeščati trombocite, je odvisno od vzroka trombocitopenije in prisotnosti ali odsotnosti krvavitve. Po splošnih priporočilih naj bi jih nadomeščali, ko njihovo število pade pod 10 x 109 /l, saj se takrat pojavi veliko tveganje za spontane krvavitve, predvsem v osrednje živčevje.

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Podatki

Jezik:	Slovenski jezik
Leto izida:	2010
Tipologija:	1.04 - Strokovni članek
Organizacija:	OI - Onkološki inštitut Ljubljana
UDK:	616-006.6:616.15
COBISS:	967291
ISSN:	1408-1741
Matična publikacija:	Onkologija
Št. ogledov:	3160
Št. prenosov:	424
Ocena:	0 (0 glasov)
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Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Thrombocytopenia in Cancer Patients
Sekundarni povzetek:	Thrombocytopenia is a decrease in number of platelets in the peripheral blood below normal range defined for population. There is no clear-cut definition for mild, moderate and severe thrombocytopenia. However, the thrombocytopenia grades are described in cancer patients receiving systemic treatment. Thrombocytopenia causes predominately skin and mucosal hemorrhage as well as, though rarely, central nervous system (CNS) hemorrhage. Thrombocytopenia is a consequence of low production of platelets or of their increased decay and consumption, as well as of delayed release of platelets by the spleen. The main causes of thrombocytopenia in cancer patients are inhibited proliferation and maturation of megakaryocytes induced by cytostatic therapy and also, though rarely, by radiotherapy. There are also other causes, e.g. excessive infiltration of bone marrow with tumor cells, hypersplenism linked to spleen enlargement, increased decay of platelets due to the use of certain drugs (heparin), in the course of chronic leukemia and lymphoma, or in association with disseminated intravascular coagulation and sepsis. In case of severe thrombocytopenia (< 10 x 109 /l) the risk of spontaneous skin, mucosal and intracranial hemorrhage is significantly increased. These patients are also at risk of excessive postsurgical hemorrhage. Thrombocytopenia is diagnosed on the basis of complete blood count from which the grade of thrombocytopenia is also determined. In order to define the precise cause of thrombocytopenia, a detailed medical history should be collected, as well as specifically oriented clinical examination and additional laboratory tests should be performed. In some cases, aspiration biopsy of the bone marrow is required. The thrombocytopenia-related hemorrhages are treated or can be prevented by platelet replacement. The platelet count at which the replacement is required depends upon the cause of the thrombocytopenia and presence or absence of hemorrhage. The platelet transfusion is recommended when the thrombocyte count is below 10 x 109 /l in order to avoid the risk of spontaneous hemorrhages, particularly CNS hemorrhage.
Sekundarne ključne besede:	Neoplasms;Thrombocytopenia;Diagnosis;Therapy;
URN:	URN:NBN:SI
Strani:	str. 46-48
Letnik:	ǂLeto ǂ14
Zvezek:	ǂšt. ǂ1
Čas izdaje:	jun. 2010
ID:	10956496