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Der Anaesthesist

, Volume 68, Issue 2, pp 69–82 | Cite as

Maschinelle Autotransfusion

Wissenschaftliche Evidenz, klinische Praxis und rechtliche Rahmenbedingungen
  • T. SeyfriedEmail author
  • E. Hansen
Leitthema
  • 388 Downloads

Zusammenfassung

Die maschinelle Autotransfusion (MAT) ist eine effektive Methode, um die Transfusion von Fremdblut zu reduzieren. Dies wird durch eine Reihe von Metaanalysen belegt, wie eine systematische Literaturrecherche ergab. Die Methode findet insbesondere in der Orthopädie/Unfallchirurgie, der Herz-Thorax-Chirurgie, Gefäßchirurgie und der Abdominal‑/Transplantationschirurgie Anwendung. Eine Retransfusion von ungewaschenem Wund- oder Drainageblut ist nicht zulässig. Nach Bestrahlung des Wundbluts kann die MAT auch in der Tumorchirurgie angewendet werden. Bei massivem Blutverlust trägt die MAT vielfach dazu bei, überhaupt ausreichend kompatibles Blut für Transfusionen bereitstellen zu können. Für Zeugen Jehovas werden manche Operationen erst damit ermöglicht. Eine potenzielle Anwendung ist das Waschen von Fremdblutkonserven, um z. B. kaliumbedingte Arrhythmien abzuwenden, oder die Bereitstellung autologer Thrombozyten. Neben der Verträglichkeit ist v. a. die hohe Vitalität und Funktionsfähigkeit der ungelagerten autologen Erythrozyten ein Vorteil. In einer Stellungnahme hat der Arbeitskreis Blut des Bundesministeriums für Gesundheit 2014 MAT-Blut als Arzneimittel definiert und dem Arzneimittelgesetz (AMG) unterstellt. Nur über strenge Vorgaben, die in der aktuellen Novelle der Hämotherapierichtlinien festgelegt sind, ist eine „erlaubnisfreie Gewinnung und Anwendung von Blut im Rahmen der maschinellen Autotransfusion (MAT)“ weiterhin möglich. Zentrale Bedeutung gewinnen das Qualitätsmanagement der MAT und insbesondere Qualitätskontrollen. Diese beinhalten Kontrollen des Produkthämatokrits bei jeder MAT-Anwendung sowie monatliche gerätebezogene Kontrollen der Eiweiß- bzw. Albuminelimination und des Produkthämatokrits bzw. der Erythrozytenausbeute. Eine Testung auf Infektionsmarker ist nicht erforderlich. Die Anwendung von MAT muss bei den zuständigen Behörden angemeldet werden.

Schlüsselwörter

Autologe Bluttransfusion Gewinnung Herstellung Retransfusion Hämotherapierichtlinie 

Cell salvage

Scientific evidence, clinical practice and legal framework

Abstract

Cell salvage is an efficient method to reduce the transfusion of homologous banked blood, as documented by several meta-analyses detected in a systematic literature search. Cell salvage is widely used in orthopedics, trauma surgery, cardiovascular and abdominal transplantation surgery. The retransfusion of unwashed shed blood from wounds or drainage is not permitted according to German regulations. Following irradiation of wound blood, salvaged blood can also be used in tumor surgery. Cell salvage makes a valuable contribution to providing sufficient compatible blood for transfusions in cases of massive blood loss. Certain surgical procedures for Jehovah’s Witnesses are only possible with the use of cell salvage. Another possible use is the washing of homologous banked blood, e. g. to prevent potassium-induced arrhythmia or sequestration of autologous platelets. Other advantages besides a good compatibility are the high vitality and functionality of the unstored autologous red blood cells. These have been declared a pharmaceutical product by the German transfusion task force in 2014, so that the autologous red blood cells are now under the control of the Pharmaceutical Products Act (AMG). The new hemotherapy guidelines, however, tolerate cell salvage only under strict rules, whereby the production of autologous blood during or after surgery is still possible without additional special permits. The new guidelines now require the introduction of a quality management system for cell salvage and regular quality controls. These quality controls include a control of the product hematocrit for every application, monthly controls of the protein and albumin elimination rates and the erythrocyte recovery rate for each cell salvage device. Testing for infection markers is not required. The application of cell salvage has to be reported to the appropriate authorities.

Keywords

Autologous blood transfusion Harvesting Production Retransfusion Hemotherapy guidelines 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Seyfried und E. Hansen haben gleichermaßen mit den Geräteherstellern Fresenius Kabi, Haemonetics, USA, sowie LivaNova, Italien, in Fortbildungen, Workshops zu Qualitätsmanagement und Studien wissenschaftlich zusammengearbeitet.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für AnästhesiologieUniversitätsklinikum RegensburgRegensburgDeutschland

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