Die autologe Blutspende ist in der Evolution begriffen. Anfang der 80er-Jahre nahm das Interesse an der präoperativen autologen Blutspende rapide zu, als erkannt wurde, dass mit Blut das HIV-Virus übertragen werden kann. Seit 1992 haben jedoch die Aktivitäten auf diesem Gebiet deutlich abgenommen, bei gleichzeitiger erhöhter Sicherheit der Bluttransfusion. Die Gründe für diese Abnahme der Aktivitäten sind nicht ganz klar; zum einen wird von den Patienten aufgrund der restriktiveren Transfusionsbestimmungen die Bluttransfusion als sicherer angesehen, hinzu kommen aber auch die hohen Kosten der präoperativen autologen Blutspende, die darauf beruhen, dass 50 % der gewonnenen Transfusionseinheiten verworfen werden. Eine alternative Strategie besteht in der akuten normovolämischen Hämodilution, die bei geringeren Kosten den Vorzug hat, die Verlustraten der gewonnenen Blutkonserven gering zu halten. Ein weiterer Vorteil der akuten normovolämischen Hämodilution ist die Tatsache, dass die Blutspende immer am Patientenbett durchgeführt wird. Damit lassen sich Fehler bei der Administration der Blutkonserven vermeiden, die zu einer transfusionsbedingten Hämolyse führen können, wie das mit Blut, das präoperativ gewonnen und in der Blutbank gelagert wird, durchaus vorkommt. Das Interesse an der autologen Blutspende könnte auf diese Weise wieder neu entfacht werden, in Anbetracht der beschränkten Verfügbarkeit von Fremdblut, unabhängig von Risiko- und Kostenaspekten.
Abstract
Autologous blood procurement remains in evolution. Interest in preoperative autologous blood donation (PAD) increased substantially in the 1980‘s due to the recognition that HIV was transmissible by blood. Concomitant with increased blood safety, however, PAD activity has declined approximately 40 % since 1992. Reasons for this decline are unclear; patients may feel more comfortable with issues regarding blood safety, but associated costs and discard rates of up to 50 % of blood units are other important factors. An alternate strategy is acute normovolemic hemodilution (ANH), which has the advantages of lower costs along with no wastage of blood units. A further advantage is that since ANH units never leave the patient’s bedside, there is no possibility of an administrative error that could lead to ABO-related hemolysis (as could occur with PAD units stored in the blood bank). Concerns regarding the adequacy of national blood inventories may restimulate interest in autologous blood procurement, independent of issues regarding blood risks or costs.
1
Andriole G L, Smitz D S, Rao G, Goodnough L T, Cantalona W J.
Early complications of contemporary anatomic radical retropubic prostatectomy.
J Urology.
1994;
152
1858-1860
2
Bierbaum B E, Callaghan J J, Galante J. et al .
An analysis of blood management in patients having total hip or knee arthroplasty.
J Bone J Surg.
1999;
81A
2-10
5
Goodnough L T, Brecher M E, Kanter M H, Aubuchon J P.
Medial progress: transfusion medicine, part II. Blood conservation.
N Engl J Med.
1999;
340
525-533
6
Goodnough L T, Brecher M E, Kanter M H, Aubuchon J P.
Medial progress: transfusion medicine, part I. Blood transfusion.
N Engl J Med.
1999;
340
439-447
7
Goodnough L T, Despotis G J, Merkel K, Monk T G.
A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total hip arthroplasty.
Transfusion.
2000;
40
1054-1057
8
Goodnough L T, Grishaber J E, Birkmeyer J D. et al .
Efficacy and cost-effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures.
Urology.
1994;
44
226-231
9
Goodnough L T, Grishaber J E, Monk T G, Catalona W J.
Acute preoperative hemodilution in patients undergoing radical prostatectomy: a case study analysis of efficacy.
Anesth Analg.
1994;
78
932-937
10
Goodnough L T, Monk T G.
Evolving concepts in autologous blood procurement. Case reports of perisurgical anemia complicated by myocardial infarction.
Amer J Med.
1996;
101
12A-33S
11
Goodnough L T, Monk T G, Brecher M E.
A review of autologous blood procurement in the surgical setting: lessons learned in the last 10 years.
Vox Sang.
1996;
71
13-21
13
Goodnough L T, Monk T G, Brecher M E.
Acute normovolemic hemodilution should replace preoperative autologous blood donation before elective surgery.
Transfusion.
1998;
38
473-476
14
Goodnough L T, Price T H, Friedman K D. et al .
A phase III trial of recombinant human erythropoietin therapy in non-anemic orthopedic patients subjected to aggressive autologous blood phlebotomy: dose, response, toxicity, efficacy.
Transfusion.
1994;
34
66-71
15
Goodnough L T, Price T H, Parvin C A. et al .
Erythropoietin response to anaemia is not altered by surgery or recombinant human erythropoietin therapy.
Br J Haem.
1994;
87
695-699
16
Goodnough L T, Price T H, Rudnick S, Soegiarso R W.
Preoperative red blood cell production in patients undergoing aggressive autologous blood phlebotomy with and without erythropoietin therapy.
Transfusion.
1992;
32
441-445
17
Goodnough L T, Rudnick S, Price T H. et al .
Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy.
N Engl J Med.
1989;
321
1163-1167
19
Hebert P C, Yetisir E, Martin C. et al .
Is a low transfusion threshold safe in patients with cardiovascular disease?.
Crit Care Med.
2001;
29
227-234
20
Hogue C W Jr, Goodnough L T, Monk T G.
Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy.
Transfusion.
1998;
38
924-931
22
Kasper S M, Gerlich W, Buzello W.
Preoperative red cell production in patients undergoing weekly autologous blood donation.
Transfusion.
1997;
37
1058-1062
23
Kasper S M, Lazansky H, Stark C. et al .
Efficacy of oral iron supplementation is not enhanced by additional intravenous iron during autologous blood donation.
Transfusion.
1998;
38
764-770
24
Larocque B J, Gilbert K, Brien W F.
Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement.
Transfusion.
1998;
38
932-937
25
Linden J V, Wagner K, Voytovich A E, Sheehan J.
Transfusion errors in New York State: an analysis of 10 years’ experience.
Transfusion.
2000;
40
1207-1213
27
Monk T G, Goodnough L T, Birkmeyer J D. et al .
Acute normovolemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy.
Transfusion.
1995;
35
559-565
28
Monk T G, Goodnough L T, Brecher M E.
Acute normovolemic hemodilution can replace preoperative autologous donation as a method of autologous blood procurement in radical prostatectomy.
Anesth Analg.
1997;
85
953-958
29
Monk T G, Goodnough L T, Brecher M E. et al .
A prospective randomized trial of three blood conservation strategies for radical prostatectomy.
Anesth.
1999;
91
24-33
30
Ness P M, Bourke D L, Walsh P C.
A randomized trial of perioperative hemodilution versus transfusion of preoperatively deposited autologous blood in elective surgery.
Transfusion.
1991;
31
226-230
32
Petry A F, Jost T, Sievers H.
Reduction of homologous blood requirements by blood pooling at the onset of cardiopulmonary bypass.
J Thor Card Surg.
1994;
107
1210-1214
33
Popovsky M A, Whitaker B, Arnold N L.
Severe outcomes of allogeneic and autologous blood donations: frequency and characterization.
Transfusion.
1995;
35
734-737
36
Weisbach V, Corbiere C, Strasser E. et al .
The variability of compensatory erythropoiesis in repeated autologous blood donation.
Transfusion.
2001;
41
179-183
37
Weisbach V, Skoda P, Rippel R. et al .
Oral or intravenous iron as an adjunct to autologous blood donation in elective surgery: a randomized, controlled study.
Transfusion.
1999;
39
465-472
40
Wu W C, Rathmore S S, Wang J. et al .
Effectiveness of blood transfusion in elderly patients with acute myocardiac infarction.
N Engl J Med.
2001;
345
1230-1236
