Zusammenfassung
Die Transfusion von Blutprodukten hat für jede medizinische Fachrichtung eine hohe
Relevanz. Die Indikation muss allerdings sehr genau gestellt werden – besonders unter
dem Aspekt, dass Blutprodukte nicht unbegrenzt verfügbar sind. Dieser Beitrag soll
helfen, im Klinikalltag und in der Notfallmedizin richtige Entscheidungen zu treffen,
Komplikationen zu erkennen und gegebenenfalls Alternativen zur Transfusion anwenden
zu können.
Abstract
Nowadays, management of hemotherapy is regulated in Germany by the transfusion act
and several guidelines while the transfusing physician is responsible for correct
implementation at the bedside. Indications for blood products have to be carefully
adapted to the patientʼs current clinical situation and pre-existing diseases have
to be considered as well. Today, for most perioperative elective surgeries, evidence-based
transfusion thresholds for packed red blood cell concentrates (RBC) have been defined
and should be considered. Platelet concentrates (PC) have to be transfused in bleeding
patients with thrombocytopenia or -pathy. In addition, PC are indicated prophylactically
in clinically stable, not bleeding patients with a platelet trough count of less than
10/nl. Therapeutic plasma or fresh frozen plasma (FFP) is indicated for balanced substitution
of coagulation factors, coagulation inhibitors and fibrinolysis factors in massive
transfusion settings, where dilution of coagulation factors takes place. Plasma exchange
in adults with thrombotic-thrombocytopenic purpura (TTP) or adult hemolytic-uremic
syndrome (HUS) also requires FFP. In addition, FFP might be indicated, if no coagulation
factor concentrate is available (e.g. FV deficiency). Adverse transfusion reactions
are rare nowadays; however, hemolytic and allergic reactions are not too uncommon.
For severe hemolytic transfusion reactions, in almost all cases, wrong blood in tube
(WBIT) at the diagnostic bedside blood withdrawal or a mix-up of blood components
before transfusion is causative. Massive transfusion situations require a proactive
management, which includes RBC, FFP and potentially also PC and coagulation factor
concentrates. Prior to elective surgery, anemic patients should be diagnosed and treated
for the cause of their anemia, if possible.
Schlüsselwörter
Bluttransfusion - Erythrozytenkonzentrate - Thrombozytenkonzentrate - therapeutisches
Plasma - Indikationen
Key words
blood transfusion - red blood cell concentrates - platelet concentrates - fresh frozen
plasma - indications
