Immunhämatologische Untersuchungen und Blutkomponenten-Auswahl bei Früh- und Reifgeborenen

Zusammenfassung

In der vorliegenden Übersichtsarbeit diskutieren wir, wie iatrogene Blutverluste durch immunhämatologische Untersuchungen bei Früh- und Reifgeborenen minimiert werden können. Die Hauptursache für die Transfusion von Erythrozytenkonzentraten (EK) sind dabei iatrogene Blutverluste durch diagnostische Blutentnahmen. In einer Beobachtungsstudie betrug der iatrogene Blutverlust bei Frühgeborenen in den ersten 28 Lebenstagen im Median 24,2 mL/kg im Vergleich zum transfundierten EK-Volumen von 30 mL/kg im selben Zeitraum [1]. Die Reduktion von diagnostischen Blutentnahmen stellt somit eine effiziente Maßnahme zur Reduzierung von EK-Transfusionen bei Frühgeborenen dar. Rationale und bedarfsadaptierte immunhämatologische Untersuchungen können den Blutverlust reduzieren, Transfusionen vermeiden und die entstehenden Kosten senken. Ferner stellen wir dar, wie durch differenzierte Auswahl von Blutkomponenten das Auftreten unerwünschter Ereignisse bei der Transfusion von Neugeborenen verhindert werden kann und regen an, restriktivere Indikationsstellungen zur Transfusion insbesondere in der Frühgeborenenmedizin zu diskutieren.

Abstract

In the present review, we discuss how iatrogenic blood loss through immunohematologic testing can be minimized in preterm and mature infants. In this context, the main cause of red blood cell (RBC) concentrate transfusion is iatrogenic blood loss due to diagnostic blood sampling. In an observational study, the median iatrogenic blood loss in preterm infants during the first 28 days of life was 24.2 mL/kg compared with the transfused RBC volume of 30 mL/kg during the same period [1]. Thus, reduction of diagnostic blood sampling is an efficient measure to reduce RBC concentrate transfusions in preterm infants. Evidence-based immunohematologic testing can reduce blood loss, avoid transfusions, and reduce the costs incurred. Furthermore, we present how the occurrence of adverse events in neonatal transfusion can be prevented by evidence-based selection of blood components and suggest discussing more restrictive indications for transfusion, especially in premature infants.

Schlüsselwörter

Neonatale Immunhämatologie - Neonatale Erythrozytentransfusion - Neonatale Thrombozytentransfusion

Key words

neonatal immunohematology - neonatal red blood cell transfusion - neonatal platelet transfusion

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