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Ersatz des perioperativen Blutverlusts bei Karzinompatienten

Ergebnisse einer Umfrage in chirurgischen Kliniken in Deutschland

Replacement of perioperative blood loss for cancer patients

Results of a survey among surgical departments in Germany

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Zusammenfassung

Einleitung

Der Bedarf an Fremdblutkonserven für onkologische Operationen steigt trotz der Möglichkeit der immunologisch unbedenklicheren autologen Bluttransfusion. Alternativ steht die Transfusion von Eigenblut oder der Einsatz maschineller Autotransfusionsgeräte (MAT) zur Verfügung. Ziel der Umfrage war es, einen Überblick über das Transfusionsverhalten im Rahmen von Tumoroperationen zu erhalten.

Material und Methoden

Die Umfrage erfolgte über die Versendung eines Fragebogens an 90 chirurgische Kliniken. Der Fragebogen setzte sich aus Fragen zur Klinik, zum Operationsspektrum, zum Transfusionssetting, zur Fremdbluttransfusion, zur präoperativen Eigenblutspende, zum Einsatz der maschinellen Autotransfusion und zur Bestrahlung von intraoperativ mittels MAT gewonnener Konserven zusammen.

Ergebnisse

Insgesamt 60 Kliniken beantworteten den Fragebogen. Bei 95% der Kliniken fließen in die Entscheidung zur Bluttransfusion die Vorerkrankungen (88%), ein Grenz-Hb-Wert (55%) sowie der Blutverlust (28%) mit ein. Der am häufigsten durchgeführte Ersatz des perioperativen Blutverlusts bei Karzinompatienten erfolgt durch Fremdblut.

In 85% der Kliniken besteht die Möglichkeit einer präoperativen Eigenblutspende. Diese wird in 3% auch Karzinompatienten angeboten. Die MAT können 93% der Kliniken einsetzen. 10% der Kliniken verwenden die MAT auch im Rahmen von Karzinomoperationen ohne weitere Aufbereitung.

31% der Kliniken können intraoperativ gewonnenes Wundblut zur autologen Retransfusion bestrahlen. 10 Kliniken setzt die Bestrahlung der mittels MAT gewonnen Konserven ein. 5% der Kliniken führen eine Bestrahlung der intraoperativ gewonnenen autologen Konserven öfter als 15-mal pro Jahr durch.

Schlussfolgerung

Der Ersatz des perioperativen Blutverlusts bei Karzinomoperationen wird in Deutschland weitestgehend über Fremdbluttransfusionen durchgeführt. Die immunologisch weniger belastenden Optionen wie die Eigenblutspende oder die Verwendung der MAT werden kaum verwendet. Als Grund hierfür wird vor allem der Mehraufwand bzw. die onkologisch bedenkliche Retransfusion von Tumorzellen angeführt.

Abstract

Background

The need for red blood cell units in cancer surgery is increasing. The role of the better immunological options, such as preoperative blood donation or intraoperative autologous blood salvage is not known. The aim of this survey was to clarify the transfusion setting and options for cancer patients in Germany.

Method

A questionnaire was send to 90 directors of surgical departments in Germany.

Results

A total of 60 directors answered the questionnaire. In most cases the blood loss is compensated by allogenic blood transfusions. The possibility of preoperative blood donation exists in 85% of the hospitals and is offered in 3% for cancer patients.

The intraoperative blood salvage is possible in 93% of the hospitals and 10% use this procedure without an additional purifying process for cancer patients.

Of the hospitals 31% are able to irradiate blood collected intraoperatively, but only 11% use this for cancer patients.

Conclusion

Perioperative blood loss is compensated by allogenic blood transfusion. The better immunological procedures, such as preoperative blood donation or intraoperative blood salvage, are not used because of the higher costs and the possible retransfusion of tumor cells.

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Authors and Affiliations

  1. Lehrstuhl für Chirurgie I, Klinik für Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Witten/Herdecke mit Sitz in Köln, Ostmerheimer Straße 200, 51109, Köln, Deutschland

    P. Oetting, P. Metz, J. Lange, M.A. Ströhlein & M.M. Heiss

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  1. P. Oetting
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  2. P. Metz
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  3. J. Lange
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  4. M.A. Ströhlein
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Correspondence to P. Oetting.

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Oetting, P., Metz, P., Lange, J. et al. Ersatz des perioperativen Blutverlusts bei Karzinompatienten. Chirurg 81, 999–1004 (2010). https://doi.org/10.1007/s00104-010-1914-6

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  • DOI: https://doi.org/10.1007/s00104-010-1914-6

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