Patient Blood Management (Teil 1) – Individuelles Behandlungskonzept zur Reduktion und Vermeidung von Anämie, Blutverlust und -transfusionen

Zusammenfassung

„Patient Blood Management (PBM)“ ist ein multidisziplinäres, multimodales, evidenzbasiertes Behandlungsmodell mit dem Ziel, das patienteneigene Blutvolumen weitestgehend zu bewahren und optimal zu behandeln. PBM basiert auf 3 Säulen: erstens der Optimierung der patienteneigenen Erythrozytenmasse, zweitens der Minimierung von Blutungen und Blutverlusten und drittens der Erhöhung und Ausschöpfung der individuellen physiologischen Anämietoleranz der einzelnen Patienten bei gleichzeitiger Anwendung eines restriktiven Transfusionsregimes. PBM konzentriert sich insbesondere auf Patienten mit erhöhtem Transfusionsrisiko und sorgt für individualisierte Behandlungsstrategien, die Transfusionen reduzieren und häufig auch vermeiden. Dadurch werden nicht nur Risiken gemindert, sondern auch Versorgungsengpässe verringert und Kosten gespart. PBM erstreckt sich nicht nur auf den perioperativen Bereich, sondern auch auf konservative Fächer, in denen ein relevanter Blutverlust auftritt.

Durch Anwendung des PBM-Konzepts werden 3 wesentliche Einflussfaktoren für verschlechterten Outcome systematisch reduziert: Anämie, Blutverlust und Transfusionen.

Abstract

Patient blood management (PBM) is a patient-specific multidisciplinary, multimodal, evidence-based concept to appropriately conserve and manage a patient's own blood as a vital resource. PBM is based on 3 pillars: the first is the optimization of the patient's endogenous red cell mass, the second is the minimization of bleeding and blood loss and the third involves harnessing and optimizing the patient-specific physiological tolerance of anemia, including adopting more restrictive transfusion thresholds. PBM primarily identifies patients at risk of transfusion and provides a management plan aimed at reducing or eliminating the need for allogeneic transfusion, thus reducing the inherent risks, inventory pressures and the escalating costs associated with transfusion. PBM is applicable to surgical and medical patients. The application of PBM systematically reduces the impact of 3 major contributors to negative outcome: anemia, blood loss and transfusion.

Schlüsselwörter:

Patient Blood Management - Transfusion - Variabilität - Blutverlust - perioperativ

Key Words:

patient blood management - transfusion - blood loss - variability - blood ordering

Kernaussagen

• Die nicht indizierte Bluttransfusion ist verbunden mit erhöhter Infarkt- und Infektionsrate, tranfusionsassoziierter Volumenüberladung (TACO) oder transfusionsassoziiertem Lungenversagen (TRALI) sowie einer erhöhten Letalität.

• Die Behandlung mit Blutprodukten zählt heute zu den teuersten Therapieformen und macht bis zu 20 % des Medikamentenbudgets der Krankenhäuser aus.

• „Patient Blood Management“ erstreckt sich über die gesamte perioperative Phase und basiert auf 3 Säulen:

  • Optimierung des Erythrozytenvolumens

  • Minimierung des Blutverlusts

  • Erhöhung und Ausschöpfung der patientenspezifischen Anämietoleranz

• Der berechnete Blutverlust ist doppelt so hoch wie der geschätzte.

• Das Verhältnis bereitgestellter Konserven und tatsächlich transfundierter Konserven sollte nicht größer als 1,7 : 1 sein.

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