Zusammenfassung.
Die Anämie ist eine häufige Begleiterscheinung in der Chirurgie. Bei mangelnder Versorgung
des Organismus mit Sauerstoff und unzureichender kardiopulmonaler Kompensation können
vor allem im zentralen Nervensystem und Myokard irreversible Gewebeschäden entstehen.
Bluttransfusionen können dieses Risiko vermindern, aber es besteht die Gefahr der
Übertragung von Infektionskrankheiten und Immunreaktionen. Durch die Bereitstellung
von Eigenblut, intraoperative Retransfusion von Wundblut, blutsparende Operationstechniken,
Hämodilution und Medikamente konnte der Verbrauch von allogenem Blut (= Fremdblut)
vermindert werden. Allogene Blutprodukte sind aber mittlerweile sehr sicher geworden
und limitieren daher den Therapievorteil des Eigenblutes. Die Verwendung von Eigenblut
ist außerdem teurer als allogenes Blut und dem breiten Einsatz von Erythropoetin stehen
noch die hohen Kosten entgegen. Limitierte Ressourcen zwingen zur Ökonomie. Sichere
Erkenntnisse zur differenzierten Transfusionstherapie sind rar und es existiert keine
allgemeingültige Transfusionsschwelle. Bei chirurgischen Patienten ohne Risikofaktoren
scheint die angemessene Transfusionsschwelle bei 80 g/L (8 g/dl) zu liegen, während
bei Patienten mit Risikofaktoren 100 g/L (10 g/dl) gerechtfertigt erscheinen. Die
Transfusionsschwelle ist für jeden Patienten in Abhängigkeit der Grunderkrankung und
Komorbidität individuell festzulegen. Prophylaktische Transfusionen sind abzulehnen,
da sie bei kritisch Kranken zu unerwünschten Nebenwirkungen führen können.
Übersetzung fehlt.
Anemia occurs frequently in surgical patients. Reduced oxygen delivery and insufficient
cardiopulmonary compensation can induce irreversible tissue damage particularly in
the central nervous system and the myocardium. Blood transfusion can reduce this risk
but there's a danger to transmit infectious diseases and to induce immune reactions.
Preoperative autologous blood donation, intraoperative retransfusion of wound blood,
blood saving surgical techniques, hemodilution and drugs reduced the use of allogenic
blood. Meanwhile, safety of allogenic blood improved substantially causing limited
therapeutic advantage of autologous blood. The use of autologous blood is more expensive
than allogenic blood, high costs of erythropoietin hinders its broad use, and limited
funds necessitate economy. However, valid knowledge for a well-differentiated transfusion
therapy is rare and there is no general applicable threshold for transfusion at which
the benefits outweigh the risks. A hemoglobin level of 80 g/L (8 g/dl) seems an appropriate
threshold for transfusion in surgical patients with no risk factors for ischemia,
whereas a threshold of 100 g/L (10 g/dl) can be justified for patients who are considered
at risk. The threshold for transfusion varies individually dependent on disease and
comorbidity. Prophylactic transfusion cannot be endorsed since overuse in patients
undergoing cardiac surgery and critically ill patients may be associated with less
favorable outcomes.
Schlüsselwörter:
Anämie - Chirurgie - Bluttransfusion - Transfusionsrisiko - Transfusionsschwelle -
Erythropoetin.
Key words:
Anemia - surgery - blood transfusion - transfusion risk - transfusion threshold -
erythropoietin.
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Dr. med. K. Buttenschoen
Chirurgische Klinik I
Universität Ulm
Steinhövelstraße 9
89075 Ulm
Telefon: 0731/5027206
Fax: 0731/5027214
eMail: klaus.buttenschoen@medizin.uni-ulm.de
