Rationaler Einsatz von Blutprodukten – Blut – eine besondere Ressource

Zusammenfassung

Hämotherapie ist ein integraler Bestandteil der modernen Hochleistungsmedizin. Ohne die Transfusion von Erythrozyten- und Thrombozytenkonzentraten sowie Plasma wären Hochdosis-Chemotherapien bei hämatologischen und soliden Tumoren, die Transplantation hämatopoetischer Stammzellen, Organtransplantationen, große operative Eingriffe sowie ein modernes Traumamanagement nicht denkbar. In diesem Beitrag wird der aktuelle Stand der Hämotherapie, das Risiko unverwünschter Wirkungen sowie Maßnahmen zur Risikovermeidung dargestellt. Auf die hämolytischen Transfusionsreaktionen (HTR), die transfusionsassoziierte akute Lungeninsuffizienz (TRALI) und transfusionsassoziierte Infektionen wird im Besonderen eingegangen. Mit der Einführung von Nukleinsäure-Amplifikations-Testen (NAT) für HIV-1 und Hepatitis-C-Virus (HCV) kann heute die HIV- und HCV-Transmission über Blutprodukte in Deutschland nahezu vollständig verhindert werden. Aktuelle Restinfektionsrisiken werden bezogen auf Blutpräparate des Deutschen Roten Kreuzes mit 1:10,8 Millionen für HCV, 1:4,3 Millionen für HIV-1 und 1:360.000 für Hepatitis-B-Viren (HBV) angegeben.

Abstract

Haemotherapy is an integral part of modern high-tech medicine. Without supportive care including red blood cell (RBC), platelet concentrate (PC) and fresh frozen plasma (FFP) transfusion, invasive therapies such as high-dose chemotherapy regimens for haematological and solid malignancies, haematopoietic stem cell (HSC) and solid organ transplantation as well as major surgery and modern trauma management would not be possible. In this article we describe the current state of haemotherapy, the risk of adverse effects and risk minimization measures, specifically focussing on haemolytic transfusion reactions (HTR), transfusion-related lung injury (TRALI) and transfusion-transmitted infections (TTI). Aided by the introduction of NAT technology for blood component screening, the residual risk of transfusion transmitted infections was reduced to 1:10.8 million for HCV, to 1:4.3 million for HIV-1, and to 1:360,000 for HBV for blood products of the German Red Cross Blood Service.

Schlüsselwörter

Hämotherapie - Blutprodukte - hämolytische Transfusionsreaktion (HTR) - transfusionsassoziierte akute Lungeninsuffizienz (TRALI) - transfusionsassoziierte Virusinfektionen (TTVI) - transfusionsbedingte bakterielle Infektionen (TBBI)

Keywords

Haemotherapy - blood products (RBC - PC - FFP) - haemolytic transfusion reaction (HTR) - transfusion-related lung injury (TRALI) - transfusion-transmitted infection (TTI)

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