Immunmodulation durch Transfusion von Erythrozytenkonzentraten

Kernaussagen

• Die Grundlage, einen Zusammenhang zwischen Bluttransfusionen und nachteiligem klinischen Outcome anzunehmen, sind Beobachtungsstudien. Da es unmöglich ist, alle Störvariablen zu kontrollieren, ist die Aussagekraft dieser Studien allerdings eingeschränkt. So kann ein schlechteres Outcome in Beobachtungsstudien immer durch eine schwerere Erkrankung oder einen schlechteren Verlauf und nicht durch die Transfusionen verursacht worden sein.

• In den meisten randomisierten Studien mit leukozytendepletierten Produkten konnte kein Einfluss der Transfusionsstrategie auf das Outcome nachgewiesen werden. Falls keine kontrollierte Volumentherapie durchgeführt wurde, kann eine erhöhte Morbidität liberal transfundierter Patienten nicht nur durch immunologische Wirkungen der Transfusion, sondern auch durch das zusätzlich applizierte Volumen bedingt sein.

• Der fehlende Nachweis eines verschlechterten Outcomes in randomisierten Studien schließt allerdings eine mögliche Immunmodulation durch die Transfusion nicht völlig aus: Zum einen könnten die Effekte je nach Patientenkollektiv differieren, sodass sie schwer in großen Studien zu erfassen sind. Auf der anderen Seite führt die Gabe von Erythrozyten natürlich auch zu günstigen Effekten. Ein gleichbleibender globaler Outcome-Parameter kann daher auch bedeuten, dass sich Einflüsse einer EK-Transfusion im Gesamtkollektiv ausgleichen.

• Ziel zukünftiger Studien könnte daher sein, die Patienten zu identifizieren, die am ehesten von einer Transfusion profitieren. Dabei ist eine kontrollierte Volumentherapie ein wichtiger Bestandteil des Studiendesigns, um mögliche immunologische Effekte von reinen Volumenwirkungen abgrenzen zu können.

• Zurzeit ist eine generelle Beeinflussung von Morbidität bzw. Mortalität durch die Transfusion von EK nicht belegt.

Schlüsselwörter

Immunmodulation - allogene Bluttransfusion - Erythrozytentransfusion - nicht hämolytische Transfusionsreaktionen - Transfusionsrisiken

• Literatur

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