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DOI: 10.1055/s-0031-1283905
© Georg Thieme Verlag Stuttgart ˙ New York
Transfusionsstrategien: Leitliniengerechte Diagnostik und Therapie[1]
Publication History
Publication Date:
14 February 2012 (online)

Zusammenfassung
Ein zielführendes Transfusionsmanagement verlangt ein differenziertes Wissen und Handeln des transfundierenden Arztes. Dabei ist die gründliche Blutungsanamnese der Baustein jeder soliden Transfusionstherapie. Hierzu empfiehlt sich die Nutzung eines standardisierten Fragebogens zur Blutungsneigung. Er ist der Routinediagnostik überlegen. Neben der Routinediagnostik steht mit den „Point-of-care“-Systemen (POC) eine rasche und effiziente Analytik zur Verfügung.
Die Therapie sollte stets zeitnah zur Diagnostik erfolgen. Die Prävention und Korrektur der letalen Trias (Hypothermie, Azidose, Anämie) ist der Grundbaustein jeder Transfusionsstrategie. Neben den Thrombozytenpräparaten stehen gefrorenes Frischplasma (FFP) und Faktorenpräparate zur Therapie von Gerinnungsstörungen zur Verfügung. Die Empfehlungen zum Einsatz beruhen jedoch oft „nur“ auf klinischer Erfahrung.
Bei uneinheitlicher Studienlage und fehlenden klinischen Wirkungsnachweisen sollten aktuelle klinische Erfahrungen und Erkenntnisse in die Handlungsalgorithmen einfließen. Dabei ist ein standardisiertes, rasches und effektives Vorgehen unabdingbar. Mit den vorhandenen „Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten“ der Bundesärztekammer steht dem behandelnden Arzt ein wichtiges Handlungskonzept mit Schlüsselempfehlungen zum Umgang mit Blutkomponenten und ihrer Anwendung zur Verfügung.
Die transfusionsbedingten Risiken werden derzeit neu bewertet. In den Vordergrund rücken allergische Transfusionsreaktionen und das TRALI („transfusion related acute lung injury“).
Schlüsselwörter
Querschnitts-Leitlinien - Hämostase - Gerinnungsdiagnostik - „Point-of-care“-Systeme - letales Trias - Transfusions-Algorithmen - Transfusionsreaktion
1 Erstveröffentlichung des Beitrags in: Intensivmedizin up2date 2009; 5: 297–312. Die vorliegende Fassung ist überarbeitet.
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1 Erstveröffentlichung des Beitrags in: Intensivmedizin up2date 2009; 5: 297–312. Die vorliegende Fassung ist überarbeitet.
PD Dr. S. Hofer
Klinik für Anästhesiologie, Universitätsklinikum
Im Neuenheimer Feld 110
69120 Heidelberg
Email: Stefan.hofer@med.uni-heidelberg