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Patient-oriented blood management

Patient-oriented blood management

Patient-oriented blood management

The WHO (World Health Organization) has been actively promoting a PBM (Patient-Oriented Blood Management) since 2011 in order to handle blood-derived products responsibly and as safely as possible. An essential part of the PBM are measures that save people’s blood, which are tailored to the individual patient.

What has been considered indispensable for decades to save a person’s life is today seen as much more balanced and more responsible. Blood transfusions or accurate transfusion of foreign blood are in high demand, both in the public and among leading specialists. Recent studies show that the gift of third party canned blood can significantly worsen the disease after surgery.

allogeneic transfusions

According to Krankenhaus Nordwest Frankfurt, about four to six million foreign blood banks are transfused every year in the Federal Republic of Germany. The risks of such foreign blood transfusions belong after the clinic:

  1. The confusion of preserve and receiver. The resulting transfusion of blood of blood-unequal blood can lead to life-threatening reactions in the recipient.
  2. The transmission of pathogens. Particularly dreaded are the viral infections HIV and liver inflammation (cirrhosis).
  3. The weakening of the body’s defense system of the recipient by components of the blood bank. The result may be, for example, an increased risk of postoperative wound infections.

Stroke attacks, heart attacks, infections and kidney failure are increasingly possible after the administration of stored blood, according to the St. Marien Hospital in Düren. “We recommend that patients undergoing scheduled surgery undergo early intervention in large outpatient clinics in the operational departments so that any necessary action can be taken to avoid alien blood transfusions as much as possible. med. Rainer Terhorst (Chief Physician of the Department of Anesthesia and Transfusion Responsible in the St. Marien Hospital).

Transfusion of red blood cell concentrates increases mortality and negatively immunomodulatory, making patient-oriented blood management more important.

Blood management through foreign blood saving measures

Operations on the heart and large vessels are often associated with significant blood loss. The DHZB (German Heart Center Berlin), with director Prof. Dr. med. med. Dr. hc Hermann Kuppe, to avoid the transfusion of foreign blood if possible. The successes through the use and the consistent further development of all modern strategies of the so-called “foreign blood saving measures”.

  1. If necessary, administration of erythropoietin and iron supplements to stimulate blood formation before and / or after surgery.
  2. Measures to reduce blood loss during surgery. The administration of antifibrinolytic agents such as tranexamic acid to protect the coagulation system; Gentle surgical technique (minimally invasive); Keeping body temperature constant; drug lowering of blood pressure.
  3. Cell saver principle

If the blood volume situation is adequate, microsampling or volume therapy may be considered. During intraoperative bleeding, MAT or hemodilution may also be used. A patient-oriented blood management means making an individual decision in each individual case on the most sensible foreign-blood-saving measures.

Blood Management by Cell Saver

According to the Asklepios Klinik Schwalmbach (with head physician Dr. med. Andreas Hettel) it is possible to carry out various foreign blood saving measures with the aid of the most modern technology. Alien blood transfusions would be much rarer today, thanks to better perioperative monitoring (before, during or shortly after surgery) than before.

The Cell Saver Principle involves the immediate collection of the patient’s own blood, lost during and up to six hours after surgery. The blood is transferred to a sterile collection vessel, which is connected directly to the surgeon’s suction tube or to the wound drainage.

If sufficient, this blood is treated sterile, so cleaned of all impurities and concentrated. Thereafter, the purified and concentrated blood is returned to the patient in a still sterile and closed circuit via an infusion system.

Patient-oriented blood management

Why do some doctors or hospitals, with so many known risks and plenty of foreign-blood-saving measures, still tend to do transfusion transfusions than others? This question can only be answered by the respective doctor. An erythrocyte concentrate costs between 80 and 250 euros in Europe. The actual costs of provision and storage are much higher.

All that is certain is that patient-oriented blood management will become increasingly important over the next few years.

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