Patient Blood Management – Wunsch und Realität

Zusammenfassung

Die Anämiebehandlung durch Versorgung mit Eisen, Folsäure und Vitamin B12 und Stimulation der Erythropoese mit Erythropoetin bei Patienten, welche Bluttransfusionen ablehnen, ist eine paradigmatische Herausforderung an das Patient Blood Management (PBM), insbesondere in Notfallsituationen. Je nach Anämieausprägung muss mit mindestens 14 Tagen für eine vollständige Anämiekorrektur gerechnet werden. Wir stellen die Dynamik der Anämie-Entwicklung und -Erholung bei unter ‚real life‘-Bedingungen verzögertem Patient Blood Management im Fall eines Patienten vor, der Transfusionen aus religiösen Gründen ablehnte.

Abstract

The treatment of anaemia by supplementation with iron, folic acid, vitamin B12 and stimulation of erythropoiesis with erythropoietin in patients who refuse blood transfusions offers a paradigmatic challenge for Patient Blood Management (PBM), particularly in emergency situations. Depending on anaemia severity, a minimum of 14 days must be anticipated for complete anaemia correction. We present the dynamics of anaemia development and recovery in a patient in a case with delayed Patient Blood Management under ‘real-world’ conditions. The patient refused transfusions on religious grounds.

Schlüsselwörter

Anämie - Retikulozyten - Patient Blood Management - Erythropoetin - Folsäure - Transfusionsablehnung - (beispielsweise aus religiösen Gründen z.B. Zeugen Jehovas)

Keywords

Anaemia - Reticulocytes - Patient Blood Management - Erythropoietin - Folic acid - Transfusion refusal - (for example for religious reasons e.g. Jehovah's witnesses)

• Literatur

• 1 Heuberger J, Rotmans JI, Gal P. et al. Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, randomised, placebo-controlled trial. Lancet Haematol 2017; 4: e374-e386
• 2 Janssen. Fachinformation ERYPO FS. In: Janssen 2021
• 3 Ning S, Zeller MP. Management of iron deficiency. Hematology Am Soc Hematol Educ Program 2019; 2019: 315-322
• 4 Mehra T, Seifert B, Bravo-Reiter S. et al. Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs. Transfusion 2015; 55: 2807-2815
• 5 Gross I, Seifert B, Hofmann A. et al. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion 2015; 55: 1075-1081
• 6 Keding V, Zacharowski K, Bechstein WO. et al. Patient Blood Management improves outcome in oncologic surgery. World J Surg Oncol 2018; 16: 159
• 7 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
• 8 WHO. Availability, safety and quality of blood products (WHA63.12). In, WHA resolution the sixty-third world health assembly. Geneva: WHO; 2010
• 9 WHO. The urgent need to implement patient blood management: policy brief. In. World Health Organization; 2021
• 10 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
• 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 Spahn DR, Goodnough LT. Alternatives to blood transfusion. Lancet 2013; 381: 1855-1865
• 13 Bundesärztkammer. Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Richtlinie Hämotherapie). In. Berlin: Bundesärztekammer; 2023: 1-124