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DOI: 10.1055/a-1256-4487
Rationale Therapie mit Erythrozytenkonzentraten – Update 2020
Rational Therapy with Erythrocyte Concentrates – Update 2020![](https://www.thieme-connect.de/media/transfusionsmedizin/202101/lookinside/thumbnails/10-1055-a-1256-4487_tf_cme_welte-1.jpg)
Zusammenfassung
Der Einsatz von Erythrozytenkonzentraten muss dem Gebot einer rationalen Indikation folgen. Um dies weiter zu gewährleisten, wurden die 2009 publizierten und zuletzt 2014 in Teilen revidierten „Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten“ [1] der Bundesärztekammer 2020 einer systematischen Novellierung unterzogen. Der Artikel stellt sie vor.
Abstract
The use of erythrocyte concentrates (EK) must be based on a rational indication. In order to insure this, the guidelines of the German Medical Association published in 2009 and last revised in part in 2014 were subject to a systematic amendment in 2020. The clinical studies published in the past few years confirmed the basic statements of the guidelines on erythrocyte transfusion for an individually adapted but fundamentally restrictive indication. At the same time, the results of new studies on defined patient groups made it possible to further individualize the indication for erythrocyte transfusion. The indication for erythrocyte transfusion must align with the question how it is possible to compensate for anaemic oxygen deficiency in the individual case. Clinical symptoms of anaemic hypoxia that occur when the oxygen supply falls below a critical level (so-called “physiological transfusion triggers”) are the definitive indicators of erythrocyte transfusion. However, these are unspecific and cannot always be clearly determined under clinical conditions. Therefore, the current haemoglobin concentration, the general condition and those concomitant diseases that limit the individualʼs ability to compensate for anaemia must be taken into account when setting the individual indication for erythrocyte transfusion.
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Der Einsatz von Erythrozytenkonzentraten (EK) muss dem Gebot einer rationalen Indikation folgen. Um dies weiter zu gewährleisten, wurden die „Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten“ 2020 einer systematischen Novellierung unterzogen.
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Die in den vergangenen Jahren publizierten klinischen Studien bestätigten die seinerzeitigen Grundaussagen der Leitlinien zur Erythrozytentransfusion für eine individuell angepasste, grundsätzlich aber restriktive Indikationsstellung.
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Gleichzeitig ermöglichten die Ergebnisse neuer Studien an definierten Patientengruppen eine weitere Individualisierung der Indikationsstellung zur Erythrozytentransfusion.
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Für die Indikation zur Erythrozytentransfusion bleibt maßgeblich, wie es im individuellen Fall gelingt, einen anämisch bedingten Sauerstoffmangel zu kompensieren.
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Klinische Symptome der anämischen Hypoxie, die beim Unterschreiten eines kritischen Sauerstoffangebots auftreten, sog. „physiologische Transfusionstrigger“, sind streng genommen die definitiven Indikatoren zur Erythrozytentransfusion. Allerdings sind diese unspezifisch und unter klinischen Bedingungen nicht immer eindeutig zu bestimmen.
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Daher müssen bei der individuellen Indikationsstellung zur Erythrozytentransfusion die aktuelle Hämoglobinkonzentration, der Allgemeinzustand und solche Begleiterkrankungen mitbeachtet werden, welche die individuelle Fähigkeit, eine Anämie zu kompensieren, limitieren.
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Darüber hinaus müssen Ergebnisse klinischer Studien in vergleichbaren Patientengruppen in die Entscheidungsfindung mit einfließen.
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Auch die neueren klinische Studien und die darauf basierende Leitlinien bestätigen, dass bei moderater akuter und chronischer Anämie (Hämoglobin [Hb] 7 – 10 g/dl) die meisten Patienten hinsichtlich ihrer Langzeitprognose nicht von Erythrozytentransfusionen profitieren.
Schlüsselwörter
Erythrozytenkonzentrat - Anämie - hypoxische Anämie - Transfusionsindikation - Kompensationsmechanismen der AnämieKey words
red cell concentrates - anaemia - hypoxic anaemia - transfusion indication - compensation mechanisms for anaemiaPublication History
Article published online:
17 February 2021
© 2021. Thieme. All rights reserved.
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