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Indikation zur Bluttransfusion bei orthopädischen Eingriffen

Indications for blood transfusion during orthopedic surgery

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Zusammenfassung

Mit zunehmender Alterung der Bevölkerung steigt die Zahl großer orthopädischer Operationen bei alten Menschen. Hohe Blutverluste und eine reduzierte Anämietoleranz erhöhen die Wahrscheinlichkeit perioperativer Bluttransfusionen in dieser Patientengruppe. Die zu erwartende Kostensteigerung im Transfusionswesen (kostenintensives Qualitätsmanagement, Anstieg der Zahl potenzieller Empfänger bei gleichzeitig rückläufiger Spendebereitschaft) sowie das nach wie vor für den Empfänger bestehende Restrisiko von Hämolyse, Infektion und Immunsuppression verdeutlichen den sozioökoniomischen Stellenwert der prospektiven Entwicklung institutionsspezifischer Transfusionsprogramme. Der vorliegende Artikel gibt einen Überblick über (1) die (patho)physiologischen Zusammenhänge bei der Kompensation von akuter Anämie, (2) die Indikation zur Transfusion bei Patienten mit und ohne kardiovaskuläre Begleiterkrankungen sowie (3) die derzeit zur Verfügung stehenden prä- und intraoperativen Verfahren zur Reduktion von Fremdbluttransfusionen bei operativen orthopädischen Eingriffen.

Abstract

Ageing of the population increases the number of large orthopedic surgical interventions in elder people. High perioperative blood loss together with a reduced tolerance to anemia increase the transfusion probability in this patient subgroup. The expected cost explosion in the transfusion system (cost intensive quality management, imbalance between the number of donors and recipients) as well as the remaining transfusion related risk of hemolysis, infection and immunosuppression reflect the high socio-economic significance of the development of institutional transfusion programs. The present article summarizes: (1) the (patho-) physiology of anemia compensation, (2) the decision making for transfusion in healthy patients and patients with cardiovascular disease, and (3) the currently applied pre- and intraoperative techniques to reduce allogeneic transfusion in orthopedic patients.

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  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie der Johann-Wolfgang-Goethe-Universität Frankfurt

    O. Habler, J. Meier, A. Pape & B. Zwißler

  2. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie der Johann-Wolfgang-Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main

    O. Habler

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  1. O. Habler
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  2. J. Meier
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Correspondence to O. Habler.

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Habler, O., Meier, J., Pape, A. et al. Indikation zur Bluttransfusion bei orthopädischen Eingriffen. Orthopäde 33, 774–783 (2004). https://doi.org/10.1007/s00132-004-0672-x

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