Rationale Indikation zur Transfusion von Erythrozytenkonzentraten

Lernziele

• Grundlagen der Sauerstoffversorgung, der Anämie und deren physiologische Kompensationsmechanismen

• Qualitätsparameter von Erythrozytenkonzentraten

• Indikatoren einer anämischen Hypoxie – „Transfusionstrigger“

• Therapeutische Ziele einer Erythrozytentransfusion

• Transfusionsindikationen in Abhängigkeit von der Grunderkrankung/der Patientenklientel

• Transfusionsassoziierte Nebenwirkungen

• Meldewege bei Auftreten von transfusionsassoziierten Nebenwirkungen

• Korrekte Dokumentation einer Transfusion

• Literatur

• 1 Bundesärztekammer. Bundesärztekammer im Einvernehmen mit dem PEI: Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Hämotherapie), Gesamtnovelle 2005 mit Richtlinienanpassung 2010. Köln: Deutscher Ärzteverlag; 2010
• 2 Funk M, Günay S. Hämovigilanzbericht des Paul-Ehrlich-Institutes 2010. Im Internet: [e-mail]
• 3 Bundesärztekammer. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmderivaten. 4. Auf. Köln: Deutscher Ärzteverlag; 2009
• 4 Bennett-Guerrero E, Veldman TH, Doctor A et al. Evolution of adverse changes in stored RBCs. PNAS 2007; 104: 17063-17068
• 5 Koch CG, Li L, Sessler DI et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229-1239
• 6 Edgren G, Kamper-Jørgensen M, Eloranta S et al. Duration of red blood cell storage and survival of transfused patients (CME). Transfusion 2010; 50: 1185-1195 Erratum in: Transfusion 2010; 50: 1857 Erratum in: Transfusion 2010; 50: 1857
• 7 Wang D, Sun J, Solomon SB et al. Transfusion of older stored blood and risk of death: a meta-analysis. Transfusion 2012; 52: 1184-1195
• 8 Karkouti K, Stukel TA, Beattle WS et al. Relationship of erythrocyte transfusion with short- and long-term mortality in a population-based surgical cohort. Anesthesiology 2012; 117: 1175-1183
• 9 Saager L, Turan A, Dalton JE et al. Erythrocyte storage duration is not associated with increased mortality in noncardiac surgical patients. Anesthesiology [im Druck]
• 10 Atzil S, Arad M, Glasner A et al. Blood transfusion promotes cancer progression: a critical role for aged erythrocytes. Anesthesiology 2008; 108: 989-997
• 11 Gombotz H, Rehak PH, Shander A et al. Blood use in elective surgery: the austrian benchmark study. Transfusion 2007; 47: 1468-1480
• 12 Hébert PC, Van der Linden P, Biro G et al. Physiologic aspects of anemia. Crit Care Clin 2004; 20: 187-212
• 13 Carson JL, Grossman BJ, Kleinman S et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2012; 157: 49-58
• 14 Carson JL, Terrin ML, Noveck H et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365: 2453-2462
• 15 Walsh TS, McClelland DB, Lee RJ et al. Prevalence of ischaemic heart disease at admission to intensive care and its influence on red cell transfusion thresholds: multicentre Scottish Study. Br J Anaesth 2005; 94: 445-452
• 16 Deutsche Gesellschaft für Unfallchirurgie. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung, AWMF Register-Nr. 012/019. Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/012-019m_S3_Polytrauma_Schwerverletzten-Behandlung_2011-07.pdf Stand: 15.12.2012
• 17 Shander A, Javidroozi M, Ozawa S et al. What is really dangerous: anaemia or transfusion?. Br J Anaesth 2011; 107 (Suppl. 01) i41-i59
• 18 Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667-2674
• 19 Glance LG, Dick AW, Mukamel DB et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 2011; 114: 283-292
• 20 Karkoutin K, Wijeysundera DN, Yau TM et al. Advance targeted transfusion in anemic cardiac surgical patients for kidney protection. Anesthesiology 2012; 116: 13-21
• 21 Hébert PC, Wells G, Martin C et al. Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study. Crit Care 1999; 3: 57-63
• 22 Hajjar LA, Vincent JL, Galas FR et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 2010; 13: 1559-1567
• 23 Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012; (4) CD002042
• 24 Horwich TB, Fonarow GC, Hamilton MA et al. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002; 39: 1780-1786
• 25 Drüeke TB, Locatelli F, Clyne N et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006; 16: 2071-2084
• 26 Roseff SD, Luban NLC, Manno CS. Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 2002; 42: 1398-1413
• 27 Lacroix J, Hébert PC, Hutchison JS et al. Transfusion strategies for patients in pediatric intensive care units. N Eng J Med 2007; 356: 1609-1619
• 28 Willems A, Harrington K, Lacroix J et al. Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med 2010; 38: 649-656
• 29 Kasat K, Hendricks-Munoz KD, Mally PV. Neonatal red blood cell transfusions: searching for better guidelines. Blood Transfus 2011; 9: 86-94
• 30 Bell EF, Strauss RG, Widness JA et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics 2005; 115: 1685-1691
• 31 Gauvin F, Spinella PC, Lacroix J et al. Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrom in pediatric intensive care patients. Transfusion 2010; 50: 1902-1913
• 32 Schmidt M, Sireis W, Seifried E et al. Sicherheit der Blutprodukte – Update 2011. Transfusionsmedizin 2011; 1: 28-50