Patient Blood Management – Ist das Konzept auch bei Kindern sinnvoll?

Zusammenfassung

Patient Blood Management beschreibt ein interdisziplinäres Konzept, welches den adäquaten und rationalen Einsatz von Fremdblut unter Ausschöpfen von validierten Strategien zur Prävention, Diagnostik und Therapie von Anämien, die Reduktion von Blutverlusten und Alternativen zur Fremdblutgabe zum Ziel hat. Während Patient Blood Management in der Erwachsenenmedizin schon verbreitet ist, sind Konzepte für die Behandlung von Kindern noch rar. Die Grundsätze der präoperativen Evaluation mit Optimierung des Erythrozytenvolumens, der perioperativen Minimierung von Blutverlusten, sowie des differenzierten Einsatzes von Blutprodukten gelten bei Erwachsenen wie bei Kindern. Wesentliche Unterschiede bestehen hinsichtlich der Physiologie des Hämoglobin- und des kardiovaskulären Systems vor allem bei Kindern im ersten Lebensjahr. Die zuverlässige Detektion einer drohenden anämischen Hypoxie kann bei Kindern erschwert sein, standardisierte Hämoglobin-Schwellenwerte als Indikation zur Transfusion sollten immer durch eine zusätzliche an den klinischen Befunden orientierte individuelle Risiko-Nutzen-Analyse gestützt werden.

Abstract

Patient blood management describes an interdisciplinary concept which aims at rational and adequate use of blood products accompanied by strategies to prevent and treat anemia, to reduce blood loss and to use alternatives to blood transfusion. While patient blood management has been widely implemented in adult medicine, concepts for such measures in the care of children are rare. The basic principles of preoperative evaluation, optimization of blood volume, perioperative minimizing of blood loss and a differentiated use of blood products are effective both in adults and children. There are differences in the physiology of hemoglobin and cardiovascular systems, particularly in the first year of life. It can be difficult to determine impending anemic hypoxia in children, so that indication for transfusion based on standardized hemoglobin threshold values should always be supported by an individual risk-benefit analysis based on clinical assessment.

Kernaussagen

• Patient Blood Management ist ein wichtiges interdisziplinäres Projekt – für Erwachsene wie für Kinder.

• Kernelelemente des PBM sind die präoperative Optimierung des Blutvolumens, die Minimierung des perioperativen Blutverlusts sowie der differenzierte Einsatz von Blutprodukten.

• Kinder weisen v. a. im ersten Lebensjahr physiologische Besonderheiten auf, u. a. die Umstellung von fetalem auf adultes Hämoglobin mit erhöhten Hb-Werten.

• Präoperativ bestehende Anämien bei Kindern sollen abgeklärt und ggf. behandelt werden.

• Perioperative Blutverluste durch Blutentnahmen sollen minimiert werden.

• Minimalinvasive OP-Techniken und eine sorgfältige Blutstillung durch den Operateur sind von großer Bedeutung, ebenso Wärmeerhalt, Kalziumhomöostase und ein ausgeglichener Säurebasenhaushalt.

• Tranexamsäure verringert Blutverluste und kann auch bei Kindern als sicher eingestuft werden.

• Point-of-Care-assistierte Gerinnungstherapie ist ein sinnvoller Bestandteil des PBM bei Kindern.

• Die Indikationsstellung zur Transfusion sollte in Analogie zu Erwachsenen restriktiv und individuell erfolgen, in der Zusammenschau von publizierten Hb-Triggerwerten und klinischen Befunden.

Schlüsselwörter:

Kinderanästhesie - Transfusion - Patient Blood Management - Anämie

Keywords:

pediatric anesthesia - transfusion - patient blood management - anemia

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