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Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48(5): 324-334
DOI: 10.1055/s-0033-1347157
Fachwissen
Anästhesiologie & Intensivmedizin Topthema: Point-of-Care-Testing
© Georg Thieme Verlag Stuttgart · New York

Point-of-Care-Testing – Einführung in die Methodik: Indikationen und Limitationen

Introduction into "Point-of-Care" testing: indications and limitations
Michael Glas
,
Dietmar Mauer
,
Kathrin Brün
,
Thomas Volk
,
Sascha Kreuer
Further Information

Publication History

Publication Date:
12 June 2013 (online)

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Zusammenfassung

Der Einsatz moderner Point-of-Care-Geräte zur perioperativen Gerinnungsdiagnostik hat in den letzten Jahren u.a. durch die Weiterentwicklung bekannter Techniken (z.B. Thrombelastografie/-metrie) eine zunehmende Verbreitung erfahren. Durch eine verbesserte Benutzerfreundlichkeit erweitern diese Techniken das Spektrum der Gerinnungsdiagnostik im klinischen Einsatz. Doch sind sie wirklich das "Nonplusultra" in der Diagnostik der nicht chirurgischen Blutungsursache? Der Beitrag möchte Anwendungsmöglichkeiten und Grenzen der Point-of-Care-Gerinnungsdiagnostik aufzeigen.

Abstract

The advancement of well known techniques in Point-of-Care coagulation diagnostics (e.g. thromboelastography/-metry) has lead to further distribution in perioperative coagulation management. By increasing user friendliness these devices have helped to expand the spectrum of coagulation diagnostics in daily clinical routine. But can they really be considered as the ne plus ultra in diagnosis of coagulopathy? In this article the authors would like to mark up indications as wells as limitations in Point-of-Care coagulation diagnostics.

Kernaussagen

  • Die Rotationsthrombelastometrie als Weiterentwicklung der Thrombelastografie nach Hartert eignet sich zur bettseitigen Gerinnungsdiagnostik.

  • Die Thrombelastometrie weist diagnostische Lücken hinsichtlich der Erfassung primärer Hämostasestörungen (idiopathisch, medikamentös bedingt) auf. Diese können teilweise durch den zusätzlichen Einsatz der Impedanzaggregometrie geschlossen werden.

  • Die Impedanzaggregometrie ist zum Monitoring einer thrombozytenaggregationshemmenden Therapie geeignet und kann ein vermindertes Ansprechen auf diese Medikamente erfassen.

  • Der Vollblutansatz bei der POC-Diagnostik gibt das Zusammenspiel von plasmatischen Faktoren, Thrombozyten, Erythrozyten und Leukozyten bei der Hämostase wieder. Rahmenbedingungen wie Temperatur oder Kalziumkonzentration werden nicht erfasst.

  • Durch den Wegfall von Transportweg und Präanalytik der Proben ermöglicht die POC-Gerinnungsdiagnostik eine schnellere und spezifischere hämostatische Therapie.

  • Rotationsthrombelastometrie und Impedanzaggregometrie sind aufgrund ihrer einfachen Handhabung nicht nur Tools für “Gerinnungsexperten”, ihre Anwendung kann schnell erlernt werden.

  • Der Einsatz von Thrombelastometrie und Impedanzaggregometrie außerhalb zentraler Laboreinrichtungen erhöht den Aufwand zur geregelten Durchführung qualitätssichernder Maßnahmen.

  • Die zunächst erforderlichen Investitionen bei der Etablierung der POC-Gerinnungsdiagnostik können neben der Verminderung der Transfusionsraten allogener Blutprodukte längerfristig wahrscheinlich auch zu einer Kosteneinsparung beitragen.

Schlüsselwörter:

Point-of-Care - POC - Thrombelastometrie - Impedanzaggregometrie

Key words:

Point-of-Care - POC - thromboelastometry - whole blood impedance aggregometry

Ergänzendes Material

 

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