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Zentralbl Chir 2003; 128(6): 462-467
DOI: 10.1055/s-2003-40618
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© Georg Thieme Verlag Stuttgart · New York

Autologe Blutgewinnung - akute normovolämische Hämodilution vs. präoperative Eigenblutspende

Autologous blood procurement - acute normovolemic hemodilution vs. preoperative autologous blood donationL. T. Goodnough1
  • 1Medicine, Pathology and Immunology, Division of Laboratory Medicine, Washington University School of Medicine, St. Louis, MO
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Publication History

Publication Date:
16 July 2003 (online)

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Zusammenfassung

Die autologe Blutspende ist in der Evolution begriffen. Anfang der 80er-Jahre nahm das Interesse an der präoperativen autologen Blutspende rapide zu, als erkannt wurde, dass mit Blut das HIV-Virus übertragen werden kann. Seit 1992 haben jedoch die Aktivitäten auf diesem Gebiet deutlich abgenommen, bei gleichzeitiger erhöhter Sicherheit der Bluttransfusion. Die Gründe für diese Abnahme der Aktivitäten sind nicht ganz klar; zum einen wird von den Patienten aufgrund der restriktiveren Transfusionsbestimmungen die Bluttransfusion als sicherer angesehen, hinzu kommen aber auch die hohen Kosten der präoperativen autologen Blutspende, die darauf beruhen, dass 50 % der gewonnenen Transfusionseinheiten verworfen werden. Eine alternative Strategie besteht in der akuten normovolämischen Hämodilution, die bei geringeren Kosten den Vorzug hat, die Verlustraten der gewonnenen Blutkonserven gering zu halten. Ein weiterer Vorteil der akuten normovolämischen Hämodilution ist die Tatsache, dass die Blutspende immer am Patientenbett durchgeführt wird. Damit lassen sich Fehler bei der Administration der Blutkonserven vermeiden, die zu einer transfusionsbedingten Hämolyse führen können, wie das mit Blut, das präoperativ gewonnen und in der Blutbank gelagert wird, durchaus vorkommt. Das Interesse an der autologen Blutspende könnte auf diese Weise wieder neu entfacht werden, in Anbetracht der beschränkten Verfügbarkeit von Fremdblut, unabhängig von Risiko- und Kostenaspekten.

Abstract

Autologous blood procurement remains in evolution. Interest in preoperative autologous blood donation (PAD) increased substantially in the 1980‘s due to the recognition that HIV was transmissible by blood. Concomitant with increased blood safety, however, PAD activity has declined approximately 40 % since 1992. Reasons for this decline are unclear; patients may feel more comfortable with issues regarding blood safety, but associated costs and discard rates of up to 50 % of blood units are other important factors. An alternate strategy is acute normovolemic hemodilution (ANH), which has the advantages of lower costs along with no wastage of blood units. A further advantage is that since ANH units never leave the patient’s bedside, there is no possibility of an administrative error that could lead to ABO-related hemolysis (as could occur with PAD units stored in the blood bank). Concerns regarding the adequacy of national blood inventories may restimulate interest in autologous blood procurement, independent of issues regarding blood risks or costs.

Schlüsselwörter

Präoperative autologe Blutspende - akute normovolämische Hä modilution - Risiko - Kosten

Key words

Preoperative autologous blood donation - acute normovolemic hemodilution - risks - costs

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Dr. Lawrence T. Goodnough MD 

Division of Laboratory Medicine

Box 81 18 · Washington University School of Medicine

660 South Euclid Avenue

St. Louis, MO 63110

Phone: 0 01/3 14/3 62-31 86

Fax: 0 01/3 14/3 62-14 61

Email: goodnough@labmed.wustl.edu