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Patient Blood Management

Dreisäulenstrategie zur Verbesserung des Outcome durch Vermeidung allogener Blutprodukte

Patient Blood Management

Three pillar strategy to improve outcome through avoidance of allogeneic blood products

Zusammenfassung

Bluttransfusionen werden traditionell als lebensrettende Maßnahme propagiert. Tatsächlich zeigt aber die Studienlage, dass Transfusionen mengenabhängig mit einer signifikanten Erhöhung von Morbidität und Mortalität assoziiert sind. Neben den Erklärungsmodellen der Grundlagenforschung legen v. a. die Ergebnisse randomisierter kontrollierter Studien nahe, dass hier von einem kausalen Zusammenhang auszugehen ist. Daher relativiert der Stand der Wissenschaft das Bild von der lebensrettenden Bluttransfusion und weist deutlich auf die lebensbedrohende und krankheitsfördernde Wirkung dieser Intervention hin. Deshalb, und weil Transfusionen mit deutlich höheren Kosten verbunden sind, als bisher angenommen, sind bei Anämie und Blutungen neue Behandlungsansätze im Sinne des „patient blood management“ (PBM) dringend indiziert. Patient Blood Management senkt die Transfusionsrate dramatisch durch Anämiekorrektur mithilfe stimulierter Erythropoese, Minimierung perioperativer Blutverluste und Erhöhung der physiologischen Anämietoleranz. In einer Resolution der World Health Assembly ist PBM nun als Behandlungsstandard gefordert. Durch Reduktion des überhöhten Blutverbrauchs in Österreich, Deutschland und der Schweiz können Morbidität und Mortalität deutlich reduziert werden.

Abstract

Blood transfusions are commonly viewed as life-saving interventions; however, current evidence shows that blood transfusions are associated with a significant increase of morbidity and mortality in a dose-dependent relationship. Not only explanatory models of basic research but also the results from randomized controlled trials suggest a causal relationship between blood transfusion and adverse outcome. Therefore, it can be claimed that the current state of science debunks the long held belief in the so-called life-saving blood transfusion by exposing the potential for promoting disease and death. Adherence to the precautionary principle and also the fact that blood transfusions are more costly than previously assumed require novel approaches in the treatment of anemia and bleeding. Patient Blood Management (PBM) allows transfusion rates to be dramatically reduced through correcting anemia by stimulating erythropoiesis, minimization of perioperative blood loss and harnessing and optimizing the physiological tolerance of anemia. A resolution of the World Health Assembly has endorsed PBM and therefore morbidity and mortality should be significantly reduced by lowering of the currently high blood utilization rate of allogeneic blood products in Austria, Germany and Switzerland.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. Prof. Dr. Hans Gombotz hat in den vergangenen fünf Jahren Honorare und/oder Reisekostenunterstützung von folgenden Unternehmen und Einrichtungen erhalten: Australian Red Cross Blood Service, BBraun Melsungen AG, Melsungen, Deutschland, CSL Behring GmbH, Marburg, Deutschland, Ethicon Biosurgery, Federal Austrian Ministry of Health and the Western Australian Department of Health, Perth, Australien, Fresenius Kabi GmbH, Bad Homburg, Deutschland, Vifor International AG, Glattbrugg, Schweiz.

Mag. Dr. Axel Hofmann hat in den vergangenen fünf Jahren Honorare und/oder Reisekostenunterstützung von folgenden Unternehmen und Einrichtungen erhalten: Amgen GmbH, Schweiz, Australian Red Cross Blood Service, Brisbane, Australien, BBraun Melsungen AG, Melsungen, Deutschland, CSL Behring GmbH, Marburg, Deutschland, Ethicon Biosurgery, Somerville, NJ, USA, Federal Austrian Ministry of Health and the Western Australian Department of Health, Perth, Australien, Fresenius Kabi GmbH, Bad Homburg, Deutschland, Janssen-Cilag GmbH, Wien, Österreich, Johnson & Johnson Medical Pty Ltd, North Ride, Austalien, Novo Nordisk A/S, Bagsvärd, Dänemark, TEM International GmbH, München, Deutschland, United, Biosource Corporation, Bethesda, Maryland, USA, Vifor International AG, Glattbrugg, Schweiz.

Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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Correspondence to Prof. Dr. H. Gombotz.

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Gombotz, H., Hofmann, A. Patient Blood Management. Anaesthesist 62, 519–527 (2013). https://doi.org/10.1007/s00101-013-2199-1

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Schlüsselwörter

  • Transfusion
  • Blutungen
  • Anämie
  • Erythropoese
  • Outcome

Keywords

  • Transfusion
  • Blood loss
  • Anemia
  • Erythropoiesis
  • Outcome