Why can't anaemics donate blood?
Blood transfusion 2006 - old wine in new bottles
Life-saving blood has been transfused since 1936, the beginning of the Spanish civil war. The whole blood transfusion from glass bottles then lasted half a century until it was replaced by the component therapy that is still used today, i.e. with erythrocyte and platelet concentrates. The view of plasma and its stable components albumin, coagulation factors and immunoglobulin has been sharpened with increasing eyesight since the Second World War: these products are now close to perfection and practically free of side effects. This is what I mean by the title of the column above: all of the modern components have been making up our whole blood since the beginning of creation - stem cells, antithrombin III, activated protein C, factor VIII, factor VIIa and which components the inclined reader of the drug compendium (www.kompendium .ch / active ingredient: blood).
Then this makes sense: before we prescribe the expensive components, precise laboratory diagnostics are required, which lead us to the origin of the clinical symptoms. The new acquisitions are obvious here: for each blood component there is a specific laboratory test that enables us to substitute what is missing. For angioedema its C1 inhibitor (e.g. Berinert), for hypogammaglobulinemics its immunoglobulin G (Octagam, Redimune, Kiovig, ...), for hemophiliacs its Haemate or Octanine, for anemics its erythrocyte concentrate and for thrombocytopenist its platelet concentrate. Laboratory diagnostics (www.sulm.ch) moves closer to the seriously ill or operated patient with the central and practice laboratory activities. The technical term here is POCT (point-of-care-testing), i.e. bedside testing, recently even in the form of continuous monitoring, which allows the good time of the transfusion or the triggering low value to be recorded in real time.
All of this has led to a more precise transfusion therapy - in new tubes are new products, deleukocytosed, filtered, validated, virus-inactivated, registered, certified and everything else that was created is monitored for safety by a haemovigilance with eagle eyes (www.swissmedic.ch / Enter search term hemovigilance). If necessary, you can look back - the look back makes it possible to trace the received products back to the donor. Electronics (www.ehalthcare.ch) have made a decisive contribution here: RFID (radio-frequency identification), barcodes and databases make it possible.
Man has long dreamed of artificial blood, the blood substitute that never exists and will never exist! How did the author hear about the artificial O2 transport capacity (e.g. fluorocarbons), stroma-free hemoglobin or genetically engineered substitutes of stable plasma derivatives for a long career and thought that the day was not far off when blood donors would no longer be needed - far from it ! Hydroxyethyl starch substitute the volume, recombinant coagulation proteins promote coagulation, and monoclonal antibodies cause specific IgG functions in a targeted manner - but the natural mixtures of freshly frozen plasma or the life-saving red cell concentrate transfusions in the severely injured can never be replaced by pharmaceutical products. My manuscript "Transfusion-dependency in Cardiac Surgery - update 2006" will soon be published in Swiss Medical Weekly with the conclusion that fewer patients need more blood products, a consequence of the refined Ops technology, but also of the POCT analysis. Within 20 years, the cardiac surgeon needs an average of 4.8 EK / Ops instead of an average of 4.8 EK / Ops today, including priming of the extracorporeal circulation. This is progress, they reduce the consumption of blood products - but the individual patient remains vulnerable, at risk, getting older and older for heroic treatment and the disaster victim - they all need the blood donor, just in the background just in case ... Donate blood - save Life!
Urs Nydegger, Prof. Dr. med., Practice Dr. Hans-Georg Walther, Hirschengraben 10, 3011 Bern
03.10.2006 - dde
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