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DOI: 10.1055/s-0031-1271600
© Georg Thieme Verlag KG Stuttgart ˙ New York
Sicherheit der Blutprodukte – Update 2011
Publikationsverlauf
Publikationsdatum:
14. September 2011 (online)
![](https://www.thieme-connect.de/media/transfusionsmedizin/201101/lookinside/thumbnails/10.1055-s-0031-1271600-1.jpg)
Zusammenfassung
Seit der breiten Anwendung von Blutkomponenten in vielen medizinischen Fachdisziplinen besteht eine wesentliche Aufgabe der Transfusionsmedizin darin, die Sicherheit der Blutprodukte zu garantieren. Dazu gehören Maßnahmen, um immunologisch und nicht immunologisch vermittelte unerwünschte Wirkungen ebenso zu vermeiden wie die Übertragungen von Pathogenen und durch geeignete Begleitmaßnahmen langfristige Folgen wie eine transfusionsbedingte Eisenüberladung zu vermeiden. In diesem Beitrag werden wir den aktuellen Stand des Risikos unerwünschter Wirkungen sowie die Ursachen und Maßnahmen zur Risikovermeidung darstellen und gehen dabei besonders auf hämolytische Transfusionsreaktionen, die transfusionsassoziierte akute Lungeninsuffizienz, die viralen und bakteriellen transfusionsassoziierten Infektionen und die Transfusionshämosiderose ein. Dies sind Beispiele, wie durch gezielte Maßnahmen die Sicherheit der Transfusionstherapie kontinuierlich verbessert werden kann. Auch im Spenderscreening wurden die Sicherheitsmaßnahmen kontinuierlich verbessert und neue molekularbiologische Screeningmethoden, wie die der Real-Time-Polymerasekettenreaktion, wurden in das Blutspenderscreening eingeführt. Bei den viralen Infektionen erfolgt in Deutschland im Spenderscreening eine Untersuchung auf Hepatitis-A-, Hepatitis-B-, Hepatitis-C-Viren, humane Immundefizienzviren 1 / 2, Parvoviren B19 und humane Zytomegalieviren (HCMV). Alle Spenden werden dabei sowohl auf Virusantikörper als auch auf Virusantigene oder auf Virus-DNA (DNA: Desoxyribonukleinsäure) bzw. -RNA (Ribonukleinsäure) von HBV, HIV und HCV untersucht. Mithilfe dieser Maßnahmen konnte das diagnostische Fenster auf ein Minimum reduziert werden und beträgt aktuell für HBV (Hepatitis-B-Virus) 20 Tage, für HIV-1 (humanes Immundefizienzvirus) 8 Tage und für HCV (Hepatitis-C-Virus) 4 Tage. Das Restinfektionsrisiko beträgt für diese Viren 1 : 360 000 für HBV, 1 : 4,3 Mio. für HIV-1 und 1 : 10,88 Mio. für HCV. Ferner gibt es transfusionsmedizinisch relevante Viren, die nur eine regionale Bedeutung haben wie z. B. West-Nil-Viren (WNV) oder Chikungunya-Viren (CHIKV). Blutspenden werden auf diese Viren nur in den Ländern untersucht, in denen die Infektionen vorkommen. Bakterielle Infektionen kommen dagegen 10- bis 100-mal häufiger vor und sind vor allem relevant in Thrombozytenkonzentraten, da diese bei 22 °C ± 2 °C gelagert werden. Schwerwiegende bakterielle Übertragungen wurden in der Mehrzahl der Kasuistiken bei Thrombozytenkonzentraten beobachtet, die am Ende der Haltbarkeit transfundiert wurden. Aus diesem Grund wurde in Deutschland die maximale Haltbarkeit im Jahr 2008 von 5 auf 4 Tage reduziert. Aktuell besteht jedoch die Möglichkeit, verschiedene bakterielle Schnelltestmethoden in das Spenderscreening zu integrieren und damit die Sicherheit der Blutprodukte gegenüber bakteriellen Infektionen zu erhöhen. Alternativ stehen heute auch verschiedene Pathogenreduktionsmethoden zur Verfügung, die generell Pathogene inaktivieren können. Aufgrund einer Vielzahl von Maßnahmen (Entwicklung von modernen Screeningmethoden, Spenderauswahlverfahren, Inaktivierungsmethoden) sind die Blutprodukte heute auf einem Sicherheitsstand wie nie zuvor in der Geschichte der Transfusionsmedizin.
Schlüsselwörter
hämolytische Transfusionsreaktion - transfusionsassoziierte Lungeninsuffizienz - transfusionsassoziierte Infektionen - Transfusionshämosiderose
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Prof. Dr. med. H. Schrezenmeier
Institut für Klinische Transfusionsmedizin und Immungenetik Ulm
Helmholtzstraße 10
89081 Ulm
eMail: h.schrezenmeier@blutspende.de