Anämie und Erythropoietin in der Intensivmedizin

Zusammenfassung

Die therapeutische Gabe von Blut und Blutkomponenten ist auch heute noch mit potenziellen Nebenwirkungen und Risiken verbunden. Außerdem können Blutkonserven zunehmend nicht mehr in ausreichendem Umfang zur Verfügung gestellt werden. Diese Umstände und die positive Erfahrung der erfolgreichen Behandlung verschiedener Anämieformen mit rekombinantem humanen Erythropoietin (rHuEPO) haben dazu geführt, dass in den letzten Jahren das Interesse an der lange wenig beachteten Anämie des kritisch kranken Patienten stark zugenommen hat. Wie bei der Anämie chronischer Erkrankungen sind die Ursachen der Anämie kritisch kranker Patienten vielfältig: vorbestehende Anämie, Blutverluste, inadäquate endogene Erythropoietinproduktion, verkürzte Erythrozytenlebensdauer, verminderte Eisenverfügbarkeit und eine direkte Hemmung der Erythropoiese durch Zytokine tragen zur Entwicklung dieser Anämie bei. Die Bedeutung der Anämie für Verlauf und Prognose kritisch kranker Patienten ist nicht geklärt, und es gibt bislang keine eindeutigen Empfehlungen für ein optimales Therapiemanagement. rHuEPO hat sich neben Strategien zur Vermeidung von Blutverlusten als attraktive Therapieoption erwiesen, die gegenwärtig in Studien evaluiert wird.

Abstract

The transfusion of red blood cells is still associated with possible adverse effects and a residual risk of transmission of viral and nonviral diseases. In addition, there is an increasing shortage of blood supply worldwide. These two facts together with the success experienced in the treatment of various types of anemia with recombinant human EPO, have recently led to an increasing interest in the anemia of critically ill patients. As in the anemia of chronic diseases there are several reasons that contribute to the development of anemia in patients on intensive care units: pre-existing anemia, blood loss, reduced red cell life span, impaired iron availbility and a direct inhibition of erythropoiesis by inflammatory cytokines. The implications of anemia for the progression and prognosis of critical illness are still unclear and the optimal treatment, including optimal “transfusion triggers” remains controversial. Recombinant human EPO has been proven to be effective in ameliorating the anemia of critical illness in several pilot studies and is currently being tested in larger trials.

Anämie - Blut - Intensivtherapie - Erythropoietin - Eisen - Entzündung

Anemia - blood - intensive care - erythropoietin - iron - inflammation

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