Novelle QLL 2020 – welche Auswirkungen haben die neu empfohlenen Hämoglobin-Transfusionstrigger auf die klinische Versorgung?

Zusammenfassung

In der Gesamtnovelle der Querschnittsleitlinie (QLL) Hämotherapie der Bundesärztekammer (BÄK) 2020 wurde der Hämoglobin-Transfusionstrigger (Hb-Transfusionstrigger) bei akutem Blutverlust ohne zusätzliche Risikofaktoren aufgrund einer Neubewertung der internationalen Evidenz von 3,7 mmol/l (6 g/dl) auf 4,3 mmol/l (7 g/dl) angepasst. Ziel der vorliegenden Studie ist die retrospektive Analyse des Transfusionsverhaltens von EK bezüglich der Maßgaben der QLL. Zu diesem Zweck analysierten wir individuelle Prä- und Posttransfusions-Hb-Werte von Erythrozytenkonzentraten (EK), die im 4. Quartal 2019 (4946 EKs, 129 560 Hb-Werte) und 2020 (5502 EKs, 134 404 Hb-Werte) am Universitätsklinikum Leipzig (UKL) transfundiert wurden. Der mediane Hb-Wert vor der Transfusion betrug 4,3 mmol/l (7 g/dl) (680 medizinische Fälle, die 2724 EK in 1801 Transfusionen im Jahr 2019 erhielten). Von allen Transfusionen im Jahr 2019 zeigten 899 (49,9%) Transfusionen Hb-Werte < 4,3 mmol/l (7 g/dl) vor der Transfusion, während 152 (8,4%) Hb-Werte < 3,7 mmol/l (6 g/dl) aufwiesen. 2020 wurden jeweils vergleichbare Ergebnisse ermittelt. Wir zeigen, dass der mediane Hb-Anstieg nach der Transfusion eines EK 0,6 mmol/l (1 g/dl) betrug. 34,7% aller Transfusionen erreichten den erwarteten Anstieg von 0,6 mmol/l (1 g/dl) pro EK. Der absolute Anstieg nahm bei Transfusionen mit mehreren EK im Vergleich zu Transfusionen mit einem EK nicht linear zu. Der Grad der Hb-Erhöhung korrelierte invers mit dem Hb-Wert vor Transfusion. Der Hb-Wert nach der Transfusion wurde bei 96,3% der Fälle innerhalb von 24 Stunden nach Hämotherapie kontrolliert. Zusammenfassend spiegelt das Transfusionsverhalten generell die Empfehlungen der Leitlinie. Um ein optimiertes, individualisiertes und dennoch restriktives Transfusionsverhalten bei EK zu erreichen, schlagen wir die Implementierung eines klinischen Entscheidungsunterstützungssystems (CDSS) bei Verschreibung jeder einzelnen EK-Transfusion vor, welches Ärzte bei der Einhaltung der Transfusionsleitlinie unterstützt und über Abweichungen informiert.

Abstract

In 2020 the German Medical Association (Bundesärztekammer, BÄK) adapted the cross-sectional guidelines for hemotherapy due to a reassessment of international evidence changing the general hemoglobin (Hb) transfusion trigger of acute blood loss from 3.7 mmol/L (6 g/dL) to 4.3 mmol/L (7 g/dL). The aim of this study is to evaluate the transfusion practice regarding adherence to current cross-sectional hemotherapy guidelines. For this purpose, we analyzed individual pre- and post-transfusion Hb thresholds of red cell concentrates (RCC) transfused in the fourth quarter of 2019 (4946 RCC transfusions, 129 560 Hb values) and 2020 (5502 RCC transfusions, 134 404 Hb values) at the University of Leipzig Medical Center (ULMC). The median pre-transfusion Hb value was 4.3 mmol/L (7 g/dL) (680 medical cases receiving 2724 RCCs in 1801 transfusions in 2019). Among all transfusions in 2019, 899 (49.9%) had a pre-transfusion Hb value < 4.3 mmol/L (7 g/dL), whereas 152 (8.4%) had an Hb value < 3.7 mmol/L (6 g/dL). Similar results were obtained for 2020. We show that median post-transfusion increase in Hb was 0.6 mmol/L (1 g/dL). 34.7% of all transfusions resulted in the expected average increase of 0.558 mmol/L (0.9 g/dL) Hb per RCC or higher. The absolute increase was higher in case of transfusions of multiple RCCs but did not increase linearly compared to transfusions with one RCC. Our results indicate that the Hb increases inversely correlated with the pre-transfusion Hb. Post-transfusion Hb was controlled within 24 h after hemotherapy in 96.3% of transfusions. In conclusion, we found that overall, the transfusion procedures reflected the guidelineʼs recommendations. To achieve an optimized, individualized yet restrictive RCC transfusion behavior, we propose the implementation of a clinical decision support system (CDSS) supporting physicians to follow the transfusion guideline and informing about deviations.

Schlüsselwörter

Anämie - Transfusionstrigger - Novelle Querschnittsleitlinie Transfusionsmedizin - Clinical Decision Support System

Key words

anemia - transfusion trigger - transfusion related cross-sectional guidelines - Transfusion-Guidelines - Clinical Decision Support System

^* geteilte Erstautorenschaft

^** geteilte Senior-Autorenschaft

Publication History

Article published online:
15 February 2022

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