RSS-Feed abonnieren
DOI: 10.1055/a-1789-0944
Etablierung eines Patient Blood Managements als Behandlungsstandard
Implementation of Patient Blood Management as Standard-of-CareAnämien zählen zu den häufigsten Krankheiten weltweit und stellen unbehandelt eine gesundheitliche Belastung dar. Insbesondere bei chirurgischen Patienten ist eine präoperative Anämie kombiniert mit operativem Blutverlust mit einem erhöhten Bedarf an Blutkonserven und schweren postoperativen Komplikationen assoziiert. Ein Patient Blood Management beinhaltet evidenzbasierte patientenorientierte Therapien und Präventionsmaßnahmen für Anämien.
Abstract
Anaemia is among the most common co-morbidity in surgical patients. However, it often remains unrecognized and untreated, which results in an increased requirement for allogeneic blood products and complications. Patient Blood Management offers patient-centred and evidence-based therapies and preventive measures for anaemia. Patient Blood Management is composed of 3 main pillars: pre-operative anaemia management, blood loss reduction and the rational use of allogeneic blood products. The World Health Organization demands the implementation of Patient Blood Management measures since 2010. However, a comprehensive implementation of Patient Blood Management as a standard-of-care is still not achieved. Here, we describe the need for a comprehensive Patient Blood Management implementation and highlight several specific Patient Blood Management measures.
-
Anämien zählen zu den häufigsten Krankheiten weltweit und stellen unbehandelt eine gesundheitliche Belastung dar.
-
Patient Blood Management als Standardbehandlungskonzept kann die Patientensicherheit fördern und zu einer Reduktion des Einsatzes von allogenen Blutprodukten führen.
-
Die WHO empfiehlt die Umsetzung von Patient Blood Management.
-
Die Maßnahmen des Patient Blood Managements umfassen folgende Bereiche: die Erkennung und Behandlung von Anämien, die Reduktion von Blutverlusten und den evidenzbasierten Einsatz von Blutkonserven.
-
Das Konzept des Patient Blood Managements erfordert eine multidisziplinäre Zusammenarbeit und wird kontinuierlich weiterentwickelt, indem die einzelnen Maßnahmen patientenorientiert individualisiert werden.
Schlüsselwörter
Anämiemanagement - Eisenmangel - Blutverlust - Transfusionen - Patient Blood ManagementPublikationsverlauf
Artikel online veröffentlicht:
12. April 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1545-1602
- 2 World Health Organization (WHO). The urgent need to implement patient blood management: policy brief. Geneva: World Health Organization; 2021. Zugriff am 03. März 2023 unter: https://apps.who.int/iris/handle/10665/346655
- 3 World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011. Zugriff am 03. März 2023 unter: https://apps.who.int/iris/bitstream/handle/10665/85839/WHO_NMH_NHD_MNM_11.1_eng.pdf
- 4 Munoz M, Gomez-Ramirez S, Campos A. et al. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus 2015; 13: 370-379
- 5 Musallam KM, Tamim HM, Richards T. et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396-1407
- 6 Padmanabhan H, Siau K, Curtis J. et al. Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic Review and Meta-Analysis. Ann Thorac Surg 2019; 108: 1840-1848
- 7 Warner MA, Hanson AC, Frank RD. et al. Prevalence of and Recovery From Anemia Following Hospitalization for Critical Illness Among Adults. JAMA Network Open 2020; 3: e2017843
- 8 Blum LV, Zierentz P, Hof L. et al. The impact of intravenous iron supplementation in elderly patients undergoing major surgery. BMC Geriatrics 2022; 22: 293
- 9 Corwin HL, Gettinger A, Pearl RG. et al. The CRIT Study: Anemia and blood transfusion in the critically ill – current clinical practice in the United States. Crit Care Med 2004; 32: 39-52
- 10 Young MF, Oaks BM, Tandon S. et al. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann NY Acad Sci 2019; 1450: 47-68
- 11 Goodnough LT, Maggio P, Hadhazy E. et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 2014; 54: 2753-2759
- 12 Maimaitiming M, Zhang C, Xie J. et al. Impact of restrictive red blood cell transfusion strategy on thrombosis-related events: A meta-analysis and systematic review. Vox Sang 2022; 117: 887-899
- 13 Bundesärztekammer. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. Gesamtnovelle 2020. Zugriff am 03. März 2023 unter: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/MuE/Querschnitts-Leitlinien_BAEK_zur_Therapie_mit_Blutkomponenten_und_Plasmaderivaten-Gesamtnovelle_2020.pdf
- 14 Camaschella C. Iron-deficiency anemia. N Engl J Med 2015; 372: 1832-1843
- 15 Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood 2019; 133: 40-50
- 16 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
- 17 Leahy MF, Hofmann A, Towler S. et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 2017; 57: 1347-1358
- 18 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 Patient’s Outcome: A Prospective, Multicenter Cohort Study With a Noninferiority Design. Ann Surg 2016; 264: 203-211
- 19 Shander A, Hardy JF, Ozawa S. et al. A Global Definition of Patient Blood Management. Anesth Analg 2022; 135: 476-488
- 20 Meybohm P, Richards T, Isbister J. et al. Patient Blood Management Bundles to Facilitate Implementation. Transfus Med Rev 2017; 31: 62-71
- 21 Vorderwulbecke G, Spies C, von Heymann C. et al. Die Kosten der präoperativen Anämie bei Hüftgelenkrevisionsoperationen. Anaesthesiologie 2023; 72: 13-20
- 22 Meybohm P, Schnitzbauer A, Bechstein WO. et al. Automatized OPS-based calculation of likelihood of RBC concentrate transfusion in a hospital. Anästh Intensivmed 2020; 61: 140-153
- 23 Munoz M, Acheson AG, Auerbach M. et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 2017; 72: 233-247
- 24 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
- 25 Dave CV, Brittenham GM, Carson JL. et al. Risks for Anaphylaxis With Intravenous Iron Formulations: A Retrospective Cohort Study. Ann Intern Med 2022; 175: 656-664
- 26 Triphaus C, Judd L, Glaser P. et al. Effectiveness of Preoperative Iron Supplementation in Major Surgical Patients with Iron Deficiency: A Prospective Observational Study. Ann Surg 2019; 274: e212-e219
- 27 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
- 28 Myles PS, Richards T, Klein A. et al. Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study. Br J Anaesth 2022; 129: 346-354
- 29 Yoo S, Bae J, Ro DH. et al. Efficacy of intra-operative administration of iron isomaltoside for preventing postoperative anaemia after total knee arthroplasty: A randomised controlled trial. Eur J Anaesthesiol 2021; 38: 358-365
- 30 Helmer P, Schlesinger T, Hottenrott S. et al. Patient Blood Management in der Geburtsvorbereitung, Geburtshilfe und postpartalen Phase. Anaesthesist 2022; 71: 171-180
- 31 Portoles J, Martin L, Broseta JJ. et al. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front Med (Lausanne) 2021; 8: 642296
- 32 Singh AK, Cizman B, Carroll K. et al. Efficacy and Safety of Daprodustat for Treatment of Anemia of Chronic Kidney Disease in Incident Dialysis Patients: A Randomized Clinical Trial. JAMA Intern Med 2022; 182: 592-602
- 33 Buchner LM, Park EJ, Bendz P. et al. Evaluation of a Clinical Decision Support System for the most evidence-based approach to managing perioperative anticoagulation. J Clin Anesth 2022; 80: 110877
- 34 Englert A, Bendz P, Group KI. KI-augmentierte perioperative klinische Entscheidungsunterstützung, KIPeriOP. Anaesthesist 2021; 70: 962-963
- 35 Taeuber I, Weibel S, Herrmann E. et al. Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality. JAMA Surg 2021; 156: e210884
- 36 Meybohm P, Choorapoikayil S, Wessels A. et al. Washed cell salvage in surgical patients: A review and meta-analysis of prospective randomized trials under PRISMA. Medicine (Baltimore) 2016; 95: e4490
- 37 Bundesärztekammer. Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Richtlinie Hämotherapie), Gesamtnovelle 2017 mit Erratum und Anpassungen und umschriebener Fortschreibung. 2021 Zugriff am 03. März 2023 unter: https://www.bundesaerztekammer.de/themen/medizin-und-ethik/wissenschaftlicher-beirat/stellungnahmen-richtlinien-jahresberichte/haemotherapie-transfusionsmedizin/richtlinie-zur-gewinnung-von-blut-und-blutbestandteilen-und-zur-anwendung-von-blutprodukten-richtlinie-haemotherapie
- 38 Frietsch T, Steinbicker AU, Hackbusch M. et al. Sicherheit der maschinellen Autotransfusion in der Tumorchirurgie. Anaesthesist 2020; 69: 331-351
- 39 Rajasekaran RB, Palmer AJR, Whitwell D. et al. The role of intraoperative cell salvage for musculoskeletal sarcoma surgery. J Bone Oncol 2021; 30: 100390
- 40 Tan JKH, Menon NV, Tan PS. et al. Presence of tumor cells in intra-operative blood salvage autotransfusion samples from hepatocellular carcinoma liver transplantation: analysis using highly sensitive microfluidics technology. HPB (Oxford) 2021; 23: 1700-1707
- 41 Winter A, Zacharowski K, Meybohm P. et al. Removal of EpCAM-positive tumor cells from blood collected during major oncological surgery using the Catuvab device – a pilot study. BMC Anesthesiol 2021; 21: 261
- 42 Dotzauer R, La Torre A, Thomas A. et al. Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison. World J Urol 2021; 39: 149-156
- 43 Riessen R, Behmenburg M, Blumenstock G. et al. A Simple “Blood-Saving Bundle” Reduces Diagnostic Blood Loss and the Transfusion Rate in Mechanically Ventilated Patients. PLoS One 2015; 10: e0138879
- 44 Schlesinger T, Kranke P, Helmer P. et al. Updated cross-sectional guidelines on therapy with blood components and plasma derivatives 2020: What’s new about erythrocytes for the anaesthesiologist?. Anästh Intensivmed 2021; 62: 463-470
- 45 Cote C, MacLeod JB, Yip AM. et al. Variation in transfusion rates within a single institution: exploring the effect of differing practice patterns on the likelihood of blood product transfusion in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2015; 149: 297-302
- 46 Augurzky ADS, Hentschker C, Mensen A. BARMER Krankenhausreport 2019. Patient Blood Management. Schriftenreihe zur Gesundheitsanalyse – Band 18. Berlin: BARMER; 2019. Zugriff am 03. März 2023 unter: https://www.barmer.de/resource/blob/1026586/97dc5e63677340532d5de29b0119881c/barmer-krankenhausreport-2019-band-18-bifg-patient-blood-management-data.pdf
- 47 Drabinski T, Zacharowski K, Meybohm P. et al. Estimating the Epidemiological and Economic Impact of Implementing Preoperative Anaemia Measures in the German Healthcare System: The Health Economic Footprint of Patient Blood Management. Adv Ther 2020; 37: 3515-3536
- 48 Piekarski F, Thalheimer M, Seyfried T. et al. Verschiedene Szenarien zu Abrechnung und Kostenerstattung eines präoperativen Managements der Eisenmangelanämie im deutschen Gesundheitssystem. Anaesthesist 2019; 68: 540-545
- 49 DRK-Blutspendedienst. Blutspendedienst warnt vor Versorgungsengpass. Zugriff am 03. März 2023 unter: https://www.blutspende-leben.de/presse/pressemitteilungen/blutspendedienst-warnt-vor-versorgungsengpass
- 50 Helmer P, Hottenrott S, Steinisch A. et al. Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss. J Clin Med 2022; 11
- 51 Koch CG, Reineks EZ, Tang AS. et al. Contemporary bloodletting in cardiac surgical care. Ann Thorac Surg 2015; 99: 779-784