[Preoperative donation of autologous blood and plasma]. / Die präoperative autologe Blut- und Plasmaspende.

The risk and side effects of homologous blood transfusion led to an increased interest in autologous transfusion concepts. Whereas peri- and intraoperative procedures are clinical methods, preoperative autologous blood donation belongs into the responsibility of a transfusion service in order to ensure qualified separation into blood components as well as correct storage and handling. Special knowledge in transfusion medicine is necessary for the application of preoperative autologous plasmapheresis. On the other hand, its use by clinicians under adequate controlled conditions seems to be rather safe. Although autologous transfusion includes the lowest risk, side reactions cannot be completely excluded. There is also a risk of secondary bacterial contamination. Side effects due to the specific composition of the various blood components, to alterations during storage and to the way of application have to be considered, too. Severe haemolytic transfusion reactions are mostly caused by exchange of blood samples, patients or blood units. They are to be expected in autologous blood transfusion as well. In addition, there is an increased risk of infection when autologous blood components are exchanged accidentally. There is only an indication for autologous blood if the total risk of autologous donation as well as transfusion in the individual case is lower than the statistical risk of homologous transfusion. Autologous blood donation should be offered to all patients undergoing elective surgery where blood is likely to be required and when blood donation is practicable. Preoperative autologous plasmapheresis is indicated in elective surgery if intra- and perioperative autotransfusion methods shall be used and a blood loss of at least 1.5 liters can be expected. There are a lot of organizational problems in autologous blood transfusion which can be solved by adequate information of all persons involved and close cooperation between clinicians and transfusion service. The high standard which was developed for homologous transfusion in the last 15 years has to be maintained for autologous blood transfusion, too.

[New aspects of blood component therapy]. / Neue Aspekte der Blutkomponententherapie.

The medical demand for factor VIII is increasing through continuously improved therapy of patients suffering from haemophilia A. The most important raw material for the production of factor VIII is fresh frozen plasma (FFP). Its clinical usage increased in the last few years dramatically. An alternative to FFP is the high grade blood component cryo-poor plasma (CPP). CPP is characterized by a deficiency of factor VIII and fibrinogen which is not of clinical relevance. It can be used instead of FFP in 95% of cases. Thus, FFP is more available for the production of factor VIII and the supply of factor VIII for haemophiliacs will improve.

[Component therapy with cryo-poor plasma (CPP)]. / Komponententherapie mit Cryo-Poor-Plasma (CPP).

National blood programs are means of strategy in the hands of the transfusiologists. Because of the dramatically increase of FFP use new ways in component therapy have to be gone. The use of CPP instead of FFP in operative medicine is one possibility to support an increasing demand of factor VIII. The first results of a clinical trial with special attention to factors I and VIII are presented in this article.

[Inhibitor hemophilia A--diagnostic and therapeutic significance of controlled substitutions with factor VIII]. / Hemmkörperhämophilie A--Diagnostische und therapeutische Bedeutung kontrollierter Substitutionen mit Faktor VIII.

10 haemophiliacs with constant low inhibitor levels to factor VIII (0.5-2.5 Bethesda units (BU) per ml) and 4 patients without antibodies were examined by a controlled substitution with factor VIII. We investigated the factor VIII in-vivo-recovery, the half disappearance time and the biological half-life. 4 different reaction patterns could be observed: 6 patients with antibodies showed the same recovery as those haemophiliacs without inhibitors but the half life was shorter. 2 inhibitor patients did not achieve the expected increments of factor VIII, but had normal half life. One patient had reduced recovery and shortened half life. Only in one patient (inhibitor levels 0.8-1.0 BU/ml) all parameters were in the normal range.

[When is fresh frozen plasma indicated?]. / Wann ist frischgefrorenes Plasma indiziert?

Fresh frozen plasma is a biological drug for the treatment of selected coagulation disturbances, a valuable substance for therapeutic plasma exchange and for the therapy of surgical haemorrhages within the blood component treatment programme. Since fresh frozen plasma is simultaneously the basic substance for the production of containing factor VIII preparations, a non-indicated excess consumption in hospitals should be avoided in order not to endanger the supply of haemophilia A patients with factor VIII.

[The fight against hemolytic disease of the newborn-- an example of interdisciplinary cooperation]. / Die Bekämpfung des Morbus hämolyticus neonatorum--ein Beispiel interdisziplinärer Kooperation.

The practical proceeding used in checking anti-D-immunoprophylaxis, in monitoring carriers of antibodies during gravidity and in treating newborns is represented. Details of patients selecting by means of step by step prenatal diagnostics as well as technique and results of intrauterine transfusion are described. After the general introduction of anti-D-prophylaxis, the morbidity resulting from morbus haemolyticus could be reduced by 80% approximately. The survival rate of foeti intrauterinely transfused amounts to 49%.

[Development of morbidity in hemolytic disease of the newborn after the introduction of immune prophylaxis at the Rostock blood exchange center from 1970 to 1980]. / Die Entwicklung der Morbidität des Morbus haemolyticus neonatorum nach Einführung der Immunprophylaxe im Blutaustauschzentrum Rostock von 1970 bis 1980.

The development of morbus haemolyticus neonatorum morbidity is demonstrated by referring to the example of the "exchange centre" in Rostock after using anti-D-immunprophylaxis for more than 10 years. The level achieved is compared with findings in international studies. The main cause for rest morbidity consists in omitting indicated immunoprophylaxis. Further progress in reducing the morbidity of morbus haemolyticus neonatorum can only be achieved by keeping physicians informed about the deleterious consequences of anti-D-immunisation having occurred.

[Lyophilized split pigskin for biological wound dressings (author's transl)]. / Lyophilisierte Schweinespalthaut als biologischer Wundverband

Experimental and clinical investigations of an unviable split pigskin preserve, produced by a fairly simple industrial process, outline the following results: The skin preserve protects a wound surface against infection and prevents loss of fluid. The reaction of the wound surface is very restricted even after repeated application, whilst the viable pigskin releases a more intense host reaction.

[Hemolytic transfusion accident due to the blood group antibody anti-Jka]. / Hämolytischer Transfusionszwischenfall durch den Blutgruppenantikörper Anti-Jka

A haemolytic transfusion incident caused by anti-Jka is reported about. In a 56 year old patient suffering from chronic iron deficiency anaemia an immunization in the Kidd system has taken place within 9 days. In the course of this immunization the fourth incompatible blood transfusion caused a severe transfusion incident. The necessity of serological compatibility testing by the indirect antiglobulin or enzyme test and the significance of making a strict indication for blood transfusions are referred to.