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Notfall- und Massivtransfusion

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Transfusionsmedizin

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Zusammenfassung

Unter Notfalltransfusion ist die aus vitaler Indikation akut durchgeführte Bluttransfusion zu verstehen. Diese Situation ist gegeben, wenn

  1. a)

    ein akuter Blutverlust eine Gefährdung des Patienten herbeigeführt hat, sodass die sofortige Transfusion von Blut und Blutkomponenten notwendig ist, oder

  2. b)

    akut ein evtl. lebensrettender Eingriff notwendig wird, bei dem ein großer Blutverlust zu erwarten ist.

Die Notfailtransfusion erfordert die schnelle Bereitstellung von kompatiblen Blutpräparaten und/oder schnelle Vorbereitung perioperativer autologer Hämotherapieverfahren. Häufig, aber nicht zwangsläufig, impliziert die Notfalitransfusion eine Massivtransfusion.

Die Massivtransfusion wird meist so definiert, dass innerhalb von 24 h mindestens ein Äquivalent des normalen Blutvolumens des betroffenen Patienten durch Blut und Blutkomponenten ersetzt wird [94]. Das entspricht beim Erwachsenen etwa der Menge von ≥ 10 Erythrozytenkonzentraten (EK). Die meisten Studien über die Massivtransfusion basieren auf dieser Voraussetzung. Die Fortschritte der Intensivmedizin und die Qualitätsverbesserung der verwendeten Blutpräparate lassen diese Definition heute jedoch nicht mehr sinnvoll erscheinen. Die später zu besprechenden spezifischen Risiken der Massivtransfusion werden nur bei schnellerer Transfusion (1 Blutvolumen in 3–4 h [18]) und/oder groößerem Transfusionsvolumen (2 Blutvolumina/24 h [66]) klinisch relevant.

Diese Definitionen sind jedoch nur retrospektiv verwertbar. Daher wurde empfohlen, von einer Massivtransfusion als Arbeitsdefinition auszugehen, wenn bezogen auf einen Erwachsenen mit normalem Körpergewicht mindestens 4 Erythrozytenkonzentrate innerhalb 1 h transfundiert werden und ein weiterer Blutbedarf erwartbar 1st [21]. Bei Transfusion leukozytendepletierter EK sollte auch diese Definition eine etwas größere Anzahl von Präparaten (5–6 Erythrozytenkonzentrate pro Stunde) für die Massivtransfusion zugrunde legen.

Da sowohl bei der Notfalitransfusion allein als auch in Kombination mit massivem Blutbedarf v.a. die kurzfristige Versorgung der Patienten mit Blutpräparaten und Blutersatzstoffen oberste Priorität besitzt, wird sich der folgende Abschnitt vordringlich diesem Aspekt widmen.

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  1. V. Kretschmer
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  1. Finkenweg 15, 35440, Linden, Deutschland

    Christian Mueller-Eckhardt

  2. Klinik und Poliklinik für Innere Medizin, Abteilung Transfusionsmedizin, Universitätsklinikum Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    Volker Kiefel

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Kretschmer, V., Weippert-Kretschmer, M. (2004). Notfall- und Massivtransfusion. In: Mueller-Eckhardt, C., Kiefel, V. (eds) Transfusionsmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-10597-9_28

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