Pape Andreas, Habler Oliver
Clinic of Anoesthesiology, Intensive Care Medicine and Pain Management, J. W. Goethe University Hospital Frankfurt am Main, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany.
Best Pract Res Clin Anaesthesiol. 2007 Jun;21(2):221-39. doi: 10.1016/j.bpa.2007.02.004.
Inherent risks and increasing costs of allogeneic transfusions underline the socioeconomic relevance of safe and effective alternatives to banked blood. The safety limits of a restrictive transfusion policy are given by a patient's individual tolerance of acute normovolaemic anaemia. latrogenic attempts to increase tolerance of anaemia are helpful in avoiding premature blood transfusions while at the same time maintaining adequate tissue oxygenation. Autologous transfusion techniques include preoperative autologous blood donation (PAD), acute normovolaemic haemodilution (ANH), and intraoperative cell salvage (ICS). The efficacy of PAD and ANH can be augmented by supplemental iron and/or erythropoietin. PAD is only cost-effective when based on a meticulous donation/transfusion plan calculated for the individual patient, and still carries the risk of mistransfusion (clerical error). In contrast, ANH has almost no risks and is more cost-effective. A significant reduction in allogeneic blood transfusions can also be achieved by ICS. Currently, some controversy regarding contraindications of ICS needs to be resolved. Artificial oxygen carriers based on perfluorocarbon (PFC) or haemoglobin (haemoglobin-based oxygen carriers, HBOCs) are attractive alternatives to allogeneic red blood cells. Nevertheless, to date no artificial oxygen carrier is available for routine clinical use, and further studies are needed to show the safety and efficacy of these substances.
异体输血的固有风险和成本增加突显了安全有效的库存血替代方法的社会经济意义。限制性输血政策的安全限度取决于患者对急性正常血容量性贫血的个体耐受性。医源性提高贫血耐受性的措施有助于避免过早输血，同时维持足够的组织氧合。自体输血技术包括术前自体血液捐献（PAD）、急性正常血容量性血液稀释（ANH）和术中血液回收（ICS）。补充铁剂和/或促红细胞生成素可增强PAD和ANH的效果。只有根据为个体患者精心计算的捐献/输血计划进行PAD才具有成本效益，且仍存在误输血（文书错误）的风险。相比之下，ANH几乎没有风险且更具成本效益。ICS也可显著减少异体输血。目前，关于ICS的禁忌症仍存在一些争议，需要解决。基于全氟化碳（PFC）或血红蛋白（血红蛋白基氧载体，HBOCs）的人工氧载体是异体红细胞的有吸引力的替代品。然而，迄今为止，尚无人工氧载体可用于常规临床应用，需要进一步研究以证明这些物质的安全性和有效性。
