Die Bedeutung der Hämolyse in Anästhesie und Intensivmedizin

Jan A. Graw; David M. Baron; Roland C.E. Francis

doi:10.1055/s-0043-121622

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53(04): 296-305
DOI: 10.1055/s-0043-121622

Fortbildung

Georg Thieme Verlag KG Stuttgart · New York

Die Bedeutung der Hämolyse in Anästhesie und Intensivmedizin

The Relevance of Hemolysis in Anesthesia and Intensive Care Medicine

Jan A. Graw

,

David M. Baron

,

Roland C.E. Francis

Abstract

Zusammenfassung

Die intravasale Hämolyse mit erhöhten Plasmakonzentrationen von zellfreiem Hämoglobin tritt nicht nur bei hämolytischen Erkrankungen auf – sie ist auch bei der Transfusion von Blutkonserven sowie bei Patienten mit ARDS, Sepsis oder kardiopulmonalem Bypass für den Krankheitsverlauf von Bedeutung. Dieser Beitrag möchte den klinisch tätigen Anästhesisten für die Relevanz der Hämolyse sowie deren Prävention und Früherkennung sensibilisieren.

Abstract

Hemolysis leads to an increase of circulating intravascular cell-free hemoglobin. Increased plasma concentrations of cell-free hemoglobin are relevant in critically ill patients because cell-free hemoglobin causes vasoconstriction by depletion of endothelial nitric oxide, oxidative stress, and inflammation. Furthermore, cell-free hemoglobin contributes to tissue injuries such as renal failure and intestinal mucosa damage after cardiac surgery. High concentrations of cell-free hemoglobin are associated with an increased mortality in patients with sepsis. Currently, it is unclear if hemolysis associated with transfusion of packed red blood cells that have been stored for prolonged periods of time is relevant for the clinical outcome. However, humans possess plasma proteins haptoglobin and hemopexin which bind to plasma hemoglobin and cell-free heme, respectively. The haptoglobin-hemoglobin and hemopexin-heme complexes are then eliminated from the plasma by hepatic or splenic uptake.

Schlüsselwörter

Hämolyse - zellfreies Hämoglobin - Häm - Bluttransfusion - Haptoglobin

Key words

hemolysis - cell-free hemoglobin - heme - blood transfusion - haptoglobin

Full Text

References

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