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Therapie mit Blutprodukten

Therapy with blood products

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Zusammenfassung

Blutprodukte werden in der Intensivmedizin oft eingesetzt. Die Evidenz hinsichtlich einer Verbesserung des klinischen Ausgangs ist jedoch meist gering. Der Trigger für eine Erythrozytentransfusion bei nicht blutenden kritisch Kranken ist aktuell ein Hämoglobinwert von 7,0 g/dl. Vor der Gabe von Thrombozytenkonzentraten müssen die Ursache der Thrombozytopenie, der klinische Zustand und der erwartete Effekt kritisch geprüft werden. Plasma sollte ebenfalls kritisch eingesetzt werden, insbesondere aufgrund der Volumenbelastung. Prothrombinkomplexkonzentrate sind bei Warfarinantagonisierung effektiver als Plasma. Albumin wird bei massiver Parazentese sowie bei der Therapie des hepatorenalen Syndroms Typ 1 und der spontanen bakteriellen Peritonitis mit guter Evidenz eingesetzt. Bei schwerer Sepsis und septischem Schock kann Albumin positive Effekte haben. Insgesamt sollten Blutprodukte restriktiv eingesetzt werden. Die Therapieentscheidung basiert auf einer kritischen Prüfung der Evidenzlage.

Abstract

Blood products are frequently used in intensive care medicine although there is little evidence of improvement in clinical outcome. The threshold for erythrocyte transfusion in non-bleeding critically ill patients is currently a hemoglobin level of 7.0 g/dl. The indications for platelet transfusion must be assessed after evaluation of the cause of thrombocytopenia, the clinical condition and the expected effect. The use of plasma should also be critically viewed, mainly due to hypervolemia. Prothrombin complex concentrates are better than plasma for warfarin reversal. There is good evidence for the use of albumin for massive paracentesis, in the treatment of hepatorenal syndrome type 1 and spontaneous bacterial peritonitis. Albumin infusion can have favorable effects in severe sepsis and septic shock. A restrictive strategy should be favored in the use of blood products and the decision should be based on a critical appraisal of the available evidence.

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  1. Interdisziplinäre Internistische Intensivmedizin, Zentrum für Hämostaseologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    S. Petros

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U. Janssens, Eschweiler

M. Joannidis, Innsbruck

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Petros, S. Therapie mit Blutprodukten. Med Klin Intensivmed Notfmed 111, 241–252 (2016). https://doi.org/10.1007/s00063-015-0138-4

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