Patient Blood Management in der Intensivmedizin

Anämien sind mit erhöhtem Transfusionsbedarf und vermehrten Komplikationen inklusive erhöhter Sterblichkeit assoziiert. Aufgrund von Entzündungen, Koagulopathien und Blutungen, iatrogenen Blutverlusten und anderen Einflussfaktoren weisen Intensivpatienten eine hohe Anämieprävalenz auf. Patient Blood Management (PBM) ist ein Konzept, das (perioperatives) Anämiemanagement, die Reduktion von Blutverlusten und den evidenzbasierten Einsatz von Bluttransfusionen fördert und Eingang in diverse Guidelines gefunden hat. Entsprechend würden Intensivpatienten von PBM enorm profitieren.

Kernaussagen

• Patient Blood Management (PBM) bietet Konzepte für (präoperatives) Anämiemanagement, die Reduktion von Blutverlusten (inklusive blutsparender Maßnahmen) und den leitliniengerechten Einsatz von Bluttransfusionen.

• Patienten auf der Intensivstation sind häufig von Entzündungsanämien oder Eisenmangelanämien mit multifaktoriellen Ursachen betroffen, die eine zusätzliche gesundheitliche Belastung neben der Hauptdiagnose darstellen.

• Nach Feststellung der Anämie sollte eine Differenzialdiagnostik durchgeführt werden, damit die Anämie adäquat behandelt werden kann, z. B. mittels i. v. Eisengaben oder die Erythropoese stimulierender Substanzen.

• Akute und chronische Blutverluste sollten mit einem algorithmusbasierten Blutungsmanagement optimiert werden.

• Iatrogene Blutverluste tragen zur Entstehung und Verschärfung von Anämien bei. Insbesondere bei Intensivpatienten gibt es aufgrund der engmaschigen Überwachung viele Optimierungsmöglichkeiten. Dazu gehören:

  • Nutzung von Blutentnahmeröhrchen mit geringerem Füllvolumen,

  • Reduktion der Blutabnahmefrequenz,

  • vermehrte Verwendung von Point-of-Care-Diagnostik,

  • Verwendung von geschlossenen Druckaufnehmersystemen.

• Die Gabe von EK-Transfusionen muss gemäß der Querschnittsleitlinie zur Therapie mit Blutkomponenten und Plasmaderivaten erfolgen. Bei der Einhaltung der Leitlinie können digitale Bestell- und Dokumentationssysteme unterstützend eingesetzt werden.

Schlüsselwörter

Patient Blood Management - Anämie - Eisensubstitution - Bluttransfusion - Eisenmangelanämie

Publikationsverlauf

Artikel online veröffentlicht:
30. März 2023

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