[How Much Blood and What Components does the Patient need Intra- and Perioperatively?]. / Wie viel Blut und welche seiner Bestandteile benötigt der Mensch intra- und perioperativ? - neue wichtige Aspekte für den Allgemein-(Viszeral-)Chirurgen aus der Transfusionsmedizin und Hämostaseologie.

By the optimised availability of less expensive and safe red cell packs and other blood products over the last 20 years, numerous surgical interventions have become possible without any demand for comments on the precise need. However, a number of publications indicates that blood transfusion may also induce disadvantageous effects on the postoperative course by immunomodulation, which requires a rather restrictive indication for transfusion. Furthermore, demographic development leads to a decrease in that portion of the population with the potential for blood donation accompanied simultaneously by an increase of the percentage of older patients with more need of blood products during medical treatment. This makes blood-sparing measures necessary. In addition, costs for red cell packs have increased, in particular, for the generally compatible blood group 0 - an extra amount for rhesus negative blood. The present narrative review highlights, therefore, important news from the clinical transfusion medicine, immunohaematology and haemostaseology and their impact on daily transfusion practice. In this context, "blood management" is considered as one of the very effective blood-sparing measures, which focusses especially i) on the substitution of iron in case of depressed preoperative haemoglobin as well as ii) to elucidate disorders of coagulation by structured medical history and, subsequently, to balance possible need by a specific plan for substitution. Simultaneously, prospective studies are initiated to investigate how far the transfusion trigger of a patient can be lowered down to a still appropriate level. As far as consolidated findings are already available, they are described with regard to the single blood components and taking into account the cross-sectional guidelines of the "Bundesärztekammer" (Federal Physicians Chamber). Finally, initial evidence is provided characterising patient- and blood donor-specific, blood group-dependent features of a reasonable haemotherapy.

[Morphologic and functional changes in thrombocytes after deep freezing with DMSO]. / Morphologische und funktionelle Veränderungen von Thrombozyten nach Tieffrierung mit DMSO.

BACKGROUND: During the past decade much work has been carried out towards establishing the optimum method for cryopreservation of platelets. Among the various cryoprotectants dimethyl sulfoxide (DMSO) has been shown to be the most effective. This report describes ultrastructural and functional changes of platelets during the deep-freezing process with DMSO. MATERIALS AND METHODS: Single-donor platelet concentrates were cryopreserved in liquid nitrogen by use of DMSO. Before, during and after the freezing process samples were taken for analysis of ultrastructure and platelet function. RESULTS: While after isolation and addition of DMSO a normal ultrastructure of platelets could be observed, clear signs of beginning cell necrosis were detected after thawing and resuspension in autologous plasma. Fibrinogen-binding capacity and platelet aggregation were significantly diminished. CONCLUSIONS: Although cryopreserved platelets are characterized by hemostatic effects in vivo, it seems conceivable that these effects could be improved by further development of platelet-freezing techniques.

[The need for thorough infection screening in donors of autologous blood]. / Die Notwendigkeit zur gründlichen Untersuchung auf Infektionskrankheiten von Spendern vor der Eigenblutspende.

To avoid the risk of diseases transmitted by homologous blood, predeposited autologous blood is useful for elective surgical patients. World-wide, there is disagreement over whether complete donor testing should or should not be done on autologous collections. There are a variety of testing concerns which have evolved into reasons for testing all autologous units for the presence of infections disease markers. One of the reasons is the risk of giving the wrong (untested) blood to the wrong patient and transmitting HIV (and thus AIDS) or viral hepatitis. Another stated concern is the risk of creating additional problems in the laboratory by treating some units differently than other units. The argument continues that without this testing, blood bank and hospital personnel may be unnecessarily exposed to blood that has the potential to cause illness. Another justification for testing is given when the blood bank participates in crossover (transfusing blood to recipients other than the autologous donor/patient).

[Use of fresh frozen plasma in surgery with special reference to autologous fresh frozen plasma]. / Einsatz von FFP im operativen Bereich unter besonderer Berücksichtigung des Eigen-FFP.

The use of FFP has increased dramatically in the last few years. In the majority of cases FFP is transfused in order to provide coagulation factors. Many physicians expect to get "better" blood parameters from concomitant FFP and red blood cell (RBC) transfusions. To avoid the risk of diseases transmitted by homologous blood predeposited autologous blood is useful for elective surgical patients. Intraoperative autotransfusion by blood salvage using a Cell Saver only provides autologous RBC without plasma, so predeposited autologous plasma seems to be a necessary supplement. However, according to the literature most patients receiving RBC units do not require concomitant FFP. Guidelines for the use of FFP based on controlled clinical trials are necessary.

[Autologous transfusion in scoliosis operations: preoperative autologous blood donations and intraoperative mechanical autotransfusion]. / Autologe Transfusion bei Skolioseoperationen: Präoperative Eigenblutspende und intraoperative maschinelle Autotransfusion.

Autologous transfusion was used to reduce the high demand for blood accompanied with scoliosis surgery. Half of the blood loss could be saved by intraoperative autotransfusion (35 patients). This resulted in a corresponding reduction in homologous transfusion. An elimination of the need for homologous blood could be achieved only by the combination of preoperative blood donation and intraoperative autotransfusion (37 patients). With freezing the predeposit blood was independent of storage time and autologous plasma was available. Thus, the risks of transfusion can be avoided.