Die Bedeutung der Hämolyse in Anästhesie und Intensivmedizin

Zusammenfassung

Die intravasale Hämolyse mit erhöhten Plasmakonzentrationen von zellfreiem Hämoglobin tritt nicht nur bei hämolytischen Erkrankungen auf – sie ist auch bei der Transfusion von Blutkonserven sowie bei Patienten mit ARDS, Sepsis oder kardiopulmonalem Bypass für den Krankheitsverlauf von Bedeutung. Dieser Beitrag möchte den klinisch tätigen Anästhesisten für die Relevanz der Hämolyse sowie deren Prävention und Früherkennung sensibilisieren.

Abstract

Hemolysis leads to an increase of circulating intravascular cell-free hemoglobin. Increased plasma concentrations of cell-free hemoglobin are relevant in critically ill patients because cell-free hemoglobin causes vasoconstriction by depletion of endothelial nitric oxide, oxidative stress, and inflammation. Furthermore, cell-free hemoglobin contributes to tissue injuries such as renal failure and intestinal mucosa damage after cardiac surgery. High concentrations of cell-free hemoglobin are associated with an increased mortality in patients with sepsis. Currently, it is unclear if hemolysis associated with transfusion of packed red blood cells that have been stored for prolonged periods of time is relevant for the clinical outcome. However, humans possess plasma proteins haptoglobin and hemopexin which bind to plasma hemoglobin and cell-free heme, respectively. The haptoglobin-hemoglobin and hemopexin-heme complexes are then eliminated from the plasma by hepatic or splenic uptake.

Kernaussagen

• Hämolyse bewirkt einen Anstieg von frei im Plasma zirkulierendem Hämoglobin.

• Erhöhte Plasmakonzentrationen von zellfreiem Hämoglobin sind besonders bei Intensivpatienten relevant, weil sie zu Vasokonstriktion führen (Depletion von endothelial generiertem NO), oxidativen Stress induzieren und Inflammationsreaktionen verstärken.

• Endorganschäden im Zusammenhang mit zellfreiem Hämoglobin betreffen z. B. Nierenversagen und Schädigungen der Darmschleimhaut bei Patienten nach kardiochirurgischen Eingriffen.

• Eine hohe Mortalitätsrate von Patienten mit Sepsis ist mit gleichzeitig erhöhten Plasmakonzentrationen von freiem Hämoglobin assoziiert. Dabei ist zum gegenwärtigen Zeitpunkt unklar, ob bei Patienten mit Sepsis zwischen Mortalität und erhöhten Plasmakonzentrationen freien Hämoglobins ein Kausalzusammenhang besteht.

• Die klinische Relevanz der Hämolyse, die im Rahmen einer Transfusion von prolongiert gelagerten Erythrozytenkonzentraten auftritt, ist aktuell unklar.

• Mit Haptoglobin und Hämopexin besitzt der menschliche Körper 2 Proteine, die zellfreies Hämoglobin bzw. freies Häm binden und aus dem Plasma eliminieren können.

Schlüsselwörter

Hämolyse - zellfreies Hämoglobin - Häm - Bluttransfusion - Haptoglobin

Key words

hemolysis - cell-free hemoglobin - heme - blood transfusion - haptoglobin

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