Anämie in der Chirurgie

Zusammenfassung.

Die Anämie ist eine häufige Begleiterscheinung in der Chirurgie. Bei mangelnder Versorgung des Organismus mit Sauerstoff und unzureichender kardiopulmonaler Kompensation können vor allem im zentralen Nervensystem und Myokard irreversible Gewebeschäden entstehen. Bluttransfusionen können dieses Risiko vermindern, aber es besteht die Gefahr der Übertragung von Infektionskrankheiten und Immunreaktionen. Durch die Bereitstellung von Eigenblut, intraoperative Retransfusion von Wundblut, blutsparende Operationstechniken, Hämodilution und Medikamente konnte der Verbrauch von allogenem Blut (= Fremdblut) vermindert werden. Allogene Blutprodukte sind aber mittlerweile sehr sicher geworden und limitieren daher den Therapievorteil des Eigenblutes. Die Verwendung von Eigenblut ist außerdem teurer als allogenes Blut und dem breiten Einsatz von Erythropoetin stehen noch die hohen Kosten entgegen. Limitierte Ressourcen zwingen zur Ökonomie. Sichere Erkenntnisse zur differenzierten Transfusionstherapie sind rar und es existiert keine allgemeingültige Transfusionsschwelle. Bei chirurgischen Patienten ohne Risikofaktoren scheint die angemessene Transfusionsschwelle bei 80 g/L (8 g/dl) zu liegen, während bei Patienten mit Risikofaktoren 100 g/L (10 g/dl) gerechtfertigt erscheinen. Die Transfusionsschwelle ist für jeden Patienten in Abhängigkeit der Grunderkrankung und Komorbidität individuell festzulegen. Prophylaktische Transfusionen sind abzulehnen, da sie bei kritisch Kranken zu unerwünschten Nebenwirkungen führen können.

Übersetzung fehlt.

Anemia occurs frequently in surgical patients. Reduced oxygen delivery and insufficient cardiopulmonary compensation can induce irreversible tissue damage particularly in the central nervous system and the myocardium. Blood transfusion can reduce this risk but there's a danger to transmit infectious diseases and to induce immune reactions. Preoperative autologous blood donation, intraoperative retransfusion of wound blood, blood saving surgical techniques, hemodilution and drugs reduced the use of allogenic blood. Meanwhile, safety of allogenic blood improved substantially causing limited therapeutic advantage of autologous blood. The use of autologous blood is more expensive than allogenic blood, high costs of erythropoietin hinders its broad use, and limited funds necessitate economy. However, valid knowledge for a well-differentiated transfusion therapy is rare and there is no general applicable threshold for transfusion at which the benefits outweigh the risks. A hemoglobin level of 80 g/L (8 g/dl) seems an appropriate threshold for transfusion in surgical patients with no risk factors for ischemia, whereas a threshold of 100 g/L (10 g/dl) can be justified for patients who are considered at risk. The threshold for transfusion varies individually dependent on disease and comorbidity. Prophylactic transfusion cannot be endorsed since overuse in patients undergoing cardiac surgery and critically ill patients may be associated with less favorable outcomes.

Schlüsselwörter:

Anämie - Chirurgie - Bluttransfusion - Transfusionsrisiko - Transfusionsschwelle - Erythropoetin.

Key words:

Anemia - surgery - blood transfusion - transfusion risk - transfusion threshold - erythropoietin.

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