Outcome-relevante Anästhesiologie: peri- und postoperative Anämiebehandlung

Zusammenfassung

Patient Blood Management (PBM) hat sich zum Ziel gesetzt, das Ausmaß einer präoperativen Anämie zu reduzieren, unnötige Blutverluste zu vermeiden und einen rationalen Umgang mit Blutprodukten zu ermöglichen. Aufgrund verschiedenster Limitationen gelingt bislang nur in wenigen deutschen Krankenhäusern eine frühzeitige Behandlung einer präoperativen Anämie. Vor diesem Hintergrund rückt die peri- und postoperative Phase zunehmend in den Fokus, um verschiedene präventive und therapeutische Maßnahmen zur Behandlung einer (postoperativen) Anämie umzusetzen. Diese werden in diesem Beitrag umfassend vorgestellt.

Aufgrund verschiedenster Limitationen gelingt bislang nur in wenigen deutschen Krankenhäusern eine frühzeitige Behandlung einer präoperativen Anämie gemäß Patient Blood Management. Vor diesem Hintergrund rückt die peri- und postoperative Phase zunehmend in den Fokus, um verschiedene präventive und therapeutische Maßnahmen zur Behandlung einer (postoperativen) Anämie umzusetzen. Diese werden im Folgenden umfassend vorgestellt.

Abstract

Patient Blood Management (PBM) aims to diagnose and treat preoperative anaemia, avoid unnecessary blood loss, and enable rational use of blood products. Due to various limitations, treatment of preoperative anaemia has been successful in only a few German hospitals to date. Thus, the peri- and postoperative phase is increasingly becoming important for implementing various preventive and therapeutic measures for the treatment of (postoperative) anaemia. These will be comprehensively presented in the following.

Schlüsselwörter

Anämie - Eisenmangel - Eisensubstitution - allogene Bluttransfusion

Key words

anaemia - iron deficiency - iron supplementation - allogeneic blood transfusion

• Literatur

• 1 Meybohm P, Richards T, Isbister J. et al. Patient Blood Management bundles to facilitate implementation. Transfus Med Rev 2017; 31: 62-71
• 2 Meybohm P, Herrmann E, Steinbicker AU. et al. Patient Blood Management is associated with a substantial reduction of red blood cell utilization and safe for patientʼs outcome: A prospective, multicenter cohort study with a noninferiority design. Ann Surg 2016; 264: 203-211
• 3 Althoff FC, Neb H, Herrmann E. et al. Multimodal Patient Blood Management Program based on a three-pillar strategy: A systematic review and meta-analysis. Ann Surg 2019; 269: 794-804
• 4 Neef V, Choorapoikayil S, Piekarski F. et al. Current concepts in the evaluation and management of preoperative anemia. Curr Opin Anaesthesiol 2021; 34: 352-356
• 5 El Khouly NI. Comparison of intravenous ferrous sucrose and oral ferrous sulphate in treatment of postpartum iron deficiency anemia. J Matern Fetal Neonatal Med 2017; 30: 967-971
• 6 Bonovas S, Fiorino G, Allocca M. et al. Intravenous versus oral iron for the treatment of anemia in inflammatory bowel disease: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95: e2308
• 7 Sultan P, Bampoe S, Shah R. et al. Oral vs. intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221: 19-29.e3
• 8 Westphal S, Isik S, Choorapoikayil S. et al. Patient Blood Management: präoperative Anämie und Fälle aus der Anämieambulanz. Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 182-193
• 9 Neef V, Baumgarten P, Noone S. et al. The impact of timing of intravenous iron supplementation on preoperative haemoglobin in patients scheduled for major surgery. Blood Transfus 2021;
• 10 Rossler J, Schoenrath F, Seifert B. et al. Iron deficiency is associated with higher mortality in patients undergoing cardiac surgery: a prospective study. Br J Anaesth 2020; 124: 25-34
• 11 Delaforce A, Duff J, Munday J. et al. Overcoming barriers to evidence-based patient blood management: a restricted review. Implement Sci 2020; 15: 6
• 12 Munoz M, Acheson AG, Bisbe E. et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia 2018; 73: 1418-1431
• 13 McEvoy MT, Shander A. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies. Am J Crit Care 2013; 22 (6 Suppl.): eS1-eS13 quiz eS14
• 14 Cook D, Guyatt G. Prophylaxis against upper gastrointestinal bleeding in hospitalized patients. N Engl J Med 2018; 378: 2506-2516
• 15 Baysan M, Arbous MS, van der Bom JG. Iatrogenic anemia: an underestimated and solvable problem in the intensive care unit. Ann Blood 2020; 5: 19
• 16 Villalta-Garcia P, Lopez-Herranz M, Mazo-Pascual S. et al. Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient. Nurs Crit Care 2017; 22: 298-304
• 17 Koch CG, Reineks EZ, Tang AS. et al. Contemporary bloodletting in cardiac surgical care. Ann Thorac Surg 2015; 99: 779-784
• 18 Meybohm P, Choorapoikayil S, Zacharowski K. Patient Blood Management in der Intensivmedizin. Intensivmedizin up2date 2017; 13: 291-307
• 19 Yokus O, Yilmaz B, Albayrak M. et al. The significance of serum transferrin receptor levels in the diagnosis of the coexistence of anemia of chronic disease and iron deficiency anemia. Eurasian J Med 2011; 43: 9-12
• 20 Ucar MA, Falay M, Dagdas S. et al. The importance of RET-He in the diagnosis of iron deficiency and iron deficiency anemia and the evaluation of response to oral iron therapy. J Med Biochem 2019; 38: 496-502
• 21 Moretti D, Goede JS, Zeder C. et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 2015; 126: 1981-1989
• 22 Fullenbach C, Stein P, Glaser P. et al. Screening for iron deficiency in surgical patients based on noninvasive zinc protoporphyrin measurements. Transfusion 2020; 60: 62-72
• 23 Kim YW, Bae JM, Park YK. et al. Effect of intravenous ferric carboxymaltose on hemoglobin response among patients with acute isovolemic anemia following gastrectomy: The FAIRY randomized clinical trial. JAMA 2017; 317: 2097-2104
• 24 Spahn DR, Schoenrath F, Spahn GH. et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet 2019; 393: 2201-2212
• 25 Richards T, Baikady RR, Clevenger B. et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet 2020; 396: 1353-1361
• 26 Peters F, Eveslage M, Gallitz I. et al. Post-operative iron carboxymaltose may have an effect on haemoglobin levels in cardiothoracic surgical patients on the ICU – an observational pilot study about anaemia treatment with intravenous iron. Transfus Med Hemother 2018; 45: 42-46
• 27 Perelman I, Winter R, Sikora L. et al. The efficacy of postoperative iron therapy in improving clinical and patient-centered outcomes following surgery: A systematic review and meta-analysis. Transfus Med Rev 2018; 32: 89-101
• 28 Litton E, Latham P, Inman J. et al. Safety and efficacy of erythropoiesis-stimulating agents in critically ill patients admitted to the intensive care unit: a systematic review and meta-analysis. Intensive Care Med 2019; 45: 1190-1199
• 29 Wijnberge M, Rellum SR, de Bruin S. et al. Erythropoiesis-stimulating agents as replacement therapy for blood transfusions in critically ill patients with anaemia: A systematic review with meta-analysis. Transfus Med 2020; 30: 433-441
• 30 Zhang Y, Chen L, Wu P. et al. Intervention with erythropoietin in sarcopenic patients with femoral intertrochanteric fracture and its potential effects on postoperative rehabilitation. Geriatr Gerontol Int 2020; 20: 150-155
• 31 Madjdpour C, Spahn DR. Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesth 2005; 95: 33-42
• 32 Muller MM, Geisen C, Zacharowski K. et al. Transfusion of packed red cells: indications, triggers and adverse events. Dtsch Arztebl Int 2015; 112: 507-517 quiz 518
• 33 Bundesärztekammer. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten Gesamtnovelle 2020. Oktober 2020. Im Internet (Stand: 03.12.2021): http://www.bundesaerztekammer.de/aerzte/medizin-ethik/wissenschaftlicher-beirat/veroeffentlichungen/haemotherapietransfusionsmedizin/querschnitt-leitlinie/
• 34 Schlesinger T, Kranke P, Helmer P. et al. Update Querschnittsleitlinie zur Therapie mit Blutkomponenten und Plasmaderivaten 2020: Was gibt es beim Thema Erythrozyten Neues für den Anästhesisten?. Anästh Intensivmed 2021; 62: 463-470
• 35 NHSBT Patient Blood Management Team in collaboration with Kings College Hospital and University Hospital Lewisham. Implementation Guide – Single Unit Transfusion Policy. Blood and Transplant 2015. Im Internet (Stand: 03.12.2021): http://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/14719/implementation-guide-single-unit-transfusion.pdf
• 36 Shih AW, Liu A, Elsharawi R. et al. Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies. Transfusion 2018; 58: 2841-2860