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
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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