Heim M U, Meyer F
Institut für Transfusionsmedizin und Immunhämatologie mit Blutbank, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
Klinik für Allgemein-, Viszeral- & Gefäßchirurgie, Universitätsklinikum Magdeburg A. ö. R., Deutschland.
Zentralbl Chir. 2016 Feb;141(1):22-30. doi: 10.1055/s-0033-1350632. Epub 2013 Sep 10.
By the optimised availability of less expensive and safe red cell packs and other blood products over the last 20 years, numerous surgical interventions have become possible without any demand for comments on the precise need. However, a number of publications indicates that blood transfusion may also induce disadvantageous effects on the postoperative course by immunomodulation, which requires a rather restrictive indication for transfusion. Furthermore, demographic development leads to a decrease in that portion of the population with the potential for blood donation accompanied simultaneously by an increase of the percentage of older patients with more need of blood products during medical treatment. This makes blood-sparing measures necessary. In addition, costs for red cell packs have increased, in particular, for the generally compatible blood group 0 - an extra amount for rhesus negative blood. The present narrative review highlights, therefore, important news from the clinical transfusion medicine, immunohaematology and haemostaseology and their impact on daily transfusion practice. In this context, "blood management" is considered as one of the very effective blood-sparing measures, which focusses especially i) on the substitution of iron in case of depressed preoperative haemoglobin as well as ii) to elucidate disorders of coagulation by structured medical history and, subsequently, to balance possible need by a specific plan for substitution. Simultaneously, prospective studies are initiated to investigate how far the transfusion trigger of a patient can be lowered down to a still appropriate level. As far as consolidated findings are already available, they are described with regard to the single blood components and taking into account the cross-sectional guidelines of the "Bundesärztekammer" (Federal Physicians Chamber). Finally, initial evidence is provided characterising patient- and blood donor-specific, blood group-dependent features of a reasonable haemotherapy.
在过去20年中，通过优化获取价格较低且安全的红细胞制剂及其他血液制品，许多外科手术得以开展，而无需对具体需求进行详细说明。然而，大量出版物表明，输血也可能通过免疫调节对术后病程产生不利影响，这就需要对输血指征进行更为严格的限定。此外，人口结构的变化导致潜在献血人群比例下降，与此同时，老年患者在医疗过程中对血液制品的需求比例增加。这使得采取血液保护措施成为必要。另外，红细胞制剂的成本有所增加，尤其是通用血型O型血，Rh阴性血的成本更高。因此，本叙述性综述重点介绍了临床输血医学、免疫血液学和止血学的重要进展及其对日常输血实践的影响。在此背景下，“血液管理”被视为非常有效的血液保护措施之一，它特别关注以下两点：一是在术前血红蛋白水平降低时补充铁剂；二是通过结构化病史明确凝血障碍，随后通过特定的替代计划平衡可能的需求。同时，已启动前瞻性研究，以探讨能将患者的输血触发点降低到何种程度且仍保持适宜水平。就已有的综合研究结果而言，将根据单一血液成分进行描述，并参考德国医师协会的横断面指南。最后，提供初步证据，描述合理血液治疗中患者和献血者特异性、血型依赖性的特征。
