Zusammenfassung
Theoretisch sind alle Erreger, die irgendwann während der Infektion im Blut zirkulieren, durch eine Bluttransfusion von einem Menschen auf einen anderen übertragbar. Die ersten Infektionserreger, für die die Übertragbarkeit durch Blut erkannt wurde, waren Plasmodien, die Erreger der Malaria, und Treponema pallidum, der Erreger der Syphilis. Seit den 1940er bis in die 1980er Jahre stand die Übertragbarkeit von Hepatitiserregern im Mittelpunkt des klinischen und wissenschaftlichen Interesses. In den frühen 1980er Jahren hat sich gezeigt, dass ein neu aufgetretenes Retrovirus, HIV (humanes Immundefizienzvirus), durch Blut und Plasmaprodukte übertragen werden kann. Die Erfahrungen mit diesem Erreger haben dazu geführt, dass man auch anderen Viren, die man wegen ihres extrem seltenen Vorkommens in unseren Breiten (z. B. HTLV-I/II, West-Nil-Virus) oder wegen ihrer geringeren klinischen Bedeutung zunächst nicht beachtet hatte (z. B. Parvovirus B19), nunmehr erhöhte Aufmerksamkeit schenkt. Überraschend aufgetretene HAV-Infektionen bei Empfängern eines bestimmten Faktor-VIII-Präparates zeigen, dass auch Erreger, die man transfusionsmedizinisch für nicht bedeutsam gehalten hatte, Probleme bereiten können. Bisher in der Transfusionsmedizin in Deutschland völlig unbekannte Erreger können durch erhöhte Aufmerksamkeit (Hepatitis-E-Virus), Epidemien in anderen Ländern und Reisen (Chigungunyavirus, Dengue), Einwanderer in die Staaten eines vereinten Europa (Trypanosoma cruzi), die Haltung exotischer Tiere (Kuhpocken) und die Änderung der klimatischen und epidemiologischen Verhältnisse (Leishmanien) an Bedeutung gewinnen.
Trotz steriler Einmalentnahmesysteme bereiten bakterielle Kontaminationen von zellulären Blutprodukten gelegentlich Probleme. Kontaminationen durch eine unerkannte Bakteriämie des Blutspenders und nachfolgendes Keimwachstum im zellulären Blutprodukt können im Einzelfall schwerwiegende Folgen für den Blutempfänger haben.
Andererseits sind, bezogen auf die Gesamtzahl gemeldeter Transfusionszwischenfälle, transfusionsübertragene bakterielle und virale Infektionen eher selten. Von den 1603 bestätigten ernsthaften Transfusionsreaktionen zwischen 1997 und 2007 in Deutschland waren 71 bakterielle und 46 virale Infektionen. Das Missverhältnis zwischen vermuteten und bestätigten transfusionsbedingten Zwischenfällen war bei den viralen Infektionen am größten: Nur jeweils einer von 63 Verdachtsfällen konnte schließlich als transfusionsbedingt bestätigt werden [316]. Das Risiko transfusionsübertragener Infektionen bleibt nach wie vor hoch in den Ländern der 3. Welt wie zum Beispiel in Afrika südlich der Sahara [298].
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Caspari, G., Gerlich, W.H. (2010). Durch Blut übertragbare Infektionskrankheiten. In: Kiefel, V., Mueller-Eckhardt, C. (eds) Transfusionsmedizin und Immunhämatologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-12765-6_38
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