Blutmanagement in der Viszeralchirurgie

Zusammenfassung

Die Transfusion von Blut und Blutprodukten muss sich an bewährten Standards und Qualitätskriterien orientieren. Das Transfusionsgesetz stellt die Grundlage dazu sicher. Die bereits existierenden Leitlinien zur Transfusion müssen genutzt werden, um für die Chirurgie und speziell für die Viszeralchirurgie Ziele der Strategie für die Transfusion zu definieren. Dabei muss es ein Ziel sein, restriktiv mit der Ressource Blut zu verfahren. Kleiner werdende Spenderkollektive, weiterhin bestehende akute und chronische Risiken der Transfusion und die Kosten zwingen zu einer Optimierung in der Handhabung. Chirurgische Disziplinen sind die hauptsächlichen Verbraucher von Blut neben der Onkologie. Die Viszeralchirurgie hat dabei einen stetig steigenden Anteil, obgleich noch konkrete Daten fehlen. Die Chirurgie der Malignome und die Alterschirurgie haben hier den höchsten Stellenwert. Neben einer interdisziplinären Strategie bestehen bereits eine große Anzahl von technischen Verfahren und Hilfsmitteln, Blut im operativen Bereich optimaler anwenden zu können. Neben der gemeinsamen Definition strategischer Ziele können Algorithmen helfen, die Abläufe im Blutmanagement zu verbessern.

Abstract

The practice of blood transfusion must be complied with the standards of regulation and quality. The German transfusion law has defined the principles. Existing guidelines should contain criteria that make each transfusion necessary to be given easily justified without further investigation. But it should be clearly understood that guidelines serve as a means of evaluating transfusion practice not as transfusion indications. Actually there are growing numbers of reports of increased morbidity and mortality due to transfusion which is known as mediate inflammatory cytokines. The new safety measures, regulatory requirements, and the continual change in demographics there are less eligible donors resulting in concerns over adequacy of blood supply so far. To date most of the surgical societies do not deal with a specific management of blood and blood products. Beside the oncologists the surgeons are the second heavy users of all blood transfused. And the visceral surgeons have increasing needs in the stuff so far as the increasing rate of patients with malignancies and older patients are concerned. There are a variety of pharmacological agents and other technologies available to optimise the need for blood, to reduce the risk from transfusion, and to preserve the supply of the blood banks. Unfortunately there is a lack of evidence-based data not only in surgical literature. This review will give an overview on data to support the use of conservative transfusion practice and then to discuss the creation of strategies and how they can work. An algorithm how to deal with an effective practice of saving blood and transfusion will also been presented. One should consider that blood and blood products including the platelets and coagulation factors could become an increasing scarce resource in the future and for which to date adequate alternatives do not exist. So we as the main users should focus on prevention and strategic planning in our specific blood management.

Schlüsselwörter

Blutmanagement - Transfusionstrigger - blutsparende Maßnahmen

Key words

Blood management - transfusion trigger - saving blood

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