Behandlung von Spenderreaktionen bei präparativen Hämapheresen

Zusammenfassung

Präparative Hämapheresen sind in vielen transfusionsmedizinischen Einrichtungen Standardverfahren zur modernen Herstellung von Blutprodukten. Sie kommen jährlich weltweit millionenfach zum Einsatz. Spenderreaktionen im Rahmen von präparativen Hämapheresen bei gesunden unverwandten Spendern sind dank moderner Apheresetechnik und hohen Prozessstandards heute ganz überwiegend als mild und klinisch nicht signifikant einzustufen. Die Kenntnis dieser, aber auch der seltenen schwerwiegenden Reaktionen, ihrer Symptome und ihrer Behandlung ist wichtig, um Spendersicherheit und Spendercompliance zu gewährleisten und Verfahrensabbrüche zu reduzieren bzw. zu vermeiden.

Abstract

Preparative hemaphereses are millionfold standard procedures for modern blood component production in many transfusion medicine establishments worldwide. Based on modern apheresis machine technique and high procedure standards the large majority of donor reactions in preparative hemaphereses are usually mild and clinically insignificant. Nevertheless, it is important to be familiar with typical and with severe donor reactions, with their symptoms and their medical treatment to assure donor safety and donor compliance and to reduce or avoid hemapheresis discontinuations.

Schlüsselwörter

Hämapheresen - Punktionskomplikationen - Zitratreaktionen - Kreislaufreaktionen - Spendercompliance - Sofortmaßnahmen - Operatorinterventionen - ärztliche Interventionen

Key words

haemaphereses - blood access injuries - immediate actions - operator interventions - physiciansʼ interventions - donor compliance

• Literatur

• 1 Stewart KR, France CR, Rader AW. et al. Phlebotomist interpersonal skill predicts a reduction in reactions among volunteer blood donors. Transfusion 2006; 46: 1394-1401
• 2 Diekamp U, Gneißl J, Rabe A. et al. Donor hemovigilance during preparatory plasmapheresis. Transfus Med Hemother 2014; 41: 123-133
• 3 Yamashita T, Yamamoto H. Avoiding Complications during Apheresis. In: Noiri E, Hanafusa N. eds. The concise Manual of Apheresis Therapy. Berlin, Heidelberg, New York: Springer; 2013: 216-218
• 4 Tomasulo P, Kamel H, Bravo M. et al. Interventions to reduce the vasovagal reaction rate in young whole blood donors. Transfusion 2011; 51: 1511-1521
• 5 Bolan CD, Greer SE, Cecco SA. et al. Comprehensive analysis of citrate effects during plateletpheresis in normal donors. Transfusion 2001; 41: 1165-1171
• 6 Laspina SJ, Browne MA, McSweeney EN. et al. QTc prolongation in apheresis platelet donors. Transfusion 2002; 42: 899-903
• 7 Ring J, Beyer K, Biedermann T. et al. Guideline for acute therapy and management of anaphylaxis. S2 guideline of DGAKI, AeDA, GPA, DAAU, BVKJ, ÖGAI, SGAI, DGAI, DGP, DGPM, AGATE and DAAB. Allergo J Int 2014; 23: 96-112
• 8 Diekamp U, Gneißl J, Rabe A. et al. Donor Hemovigilance with Blood Donation. Transfus Med Hemother 2015; 42: 181-192
• 9 Buchta C, Macher M, Bieglmayer C. et al. Reduction of adverse citrate reactions during autologous large-volume PBPC apheresis by continuous infusion of calcium-gluconate. Transfusion 2003; 43: 1615-1621
• 10 Hegde V, Setia R, Soni S. et al. Prophylactic low dose continuous calcium infusion during peripheral blood stem cell (PBSC) collections to reduce citrate related toxicity. Transfus Apher Sci 2016; 54: 373-376
• 11 Marlow SD, House M. Managing Apheresis Complications during the hematopoietic Stem Cell Collection. In: Kolonin M, Simmons P. eds. Stem Cell Mobilization. Methods in molecular Biology (Methods and Protocols), vol 904. Totowa, NJ: Humana Press; 2012: 93-96
• 12 Pamphilon D, Nacheva E, Navarrete C. et al. The use of granulocyte colony-stimulating factor in volunteer unrelated hemopoietic stem cell donors. Transfusion 2008; 48: 1495-1501
• 13 Tigue CC, McKoy JM, Evens AM. et al. Granulocyte-colony stimulating factor administration to healthy individuals and persons with chronic neutropenia or cancer: an overview of safety considerations from the Research on Adverse Drug Events and Reports project. Bone Marrow Transplant 2007; 40: 185-192
• 14 Ambruso DR. Hydroxyethylstarch and granulocyte transfusions: considerations of utility and toxicity profile for patients and donors. Transfusion 2015; 55: 911-918
• 15 Vesely TM. Air embolism during insertion of central venous catheters. J Vasc Int Radiol 2001; 12: 1291-1295
• 16 Zentrales Knochenmarkspender-Register Deutschland (ZKRD). Deutsche Standards für die nicht verwandte Blutstammzellspende, Version 11, Kap. 5.5.2. Im Internet: https://www.zkrd.de/de/_pdf/ZKRD_Standards-V11_deutsch.pdf Stand: 10.05.2017
• 17 Hölig K, Blechschmidt M, Kramer M. et al. Peripheral blood stem cell collection in allogeneic donors: impact of venous access. Transfusion 2012; 52: 2600-2605
• 18 Leitner CG, Baumgartner K, Kalhs P. et al. Regeneration, health status and quality of life after rhG-CSF-stimulated stem cell collection in healthy donors: a cross-sectional study. Bone Marrow Transplant 2009; 43: 357-363
• 19 Mirski MA, Lele AV. et al. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007; 106: 164-177
• 20 Wittenberg AG. Venous Air Embolism. eMedicine. May 2, 2006. Im Internet: http://emedicine.medscape.com/article/761367-overview Stand: 2007
• 21 Bessereau J, Genotelle N, Chabbaut C. et al. Long-term outcome of iatrogenic gas embolism. Intensive Care Med 2010; 36: 1180-1187
• 22 Lee G, Gowthami A, Arepally GM. Anticoagulation techniques in apheresis: From Heparin to citrate and beyond. J Clin Apher 2012; 27: 117-125