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Perinatale und pädiatrische Transfusionsmedizin

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Transfusionsmedizin und Immunhämatologie

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Zusammenfassung

Während der intrauterinen Entwicklung und in der frühen postnatalen Phase des Menschen werden verschiedene Perioden unterschieden:

  • die Embryonalzeit bis zum Ende der 12. Schwangerschaftswoche,

  • die Fetalzeit von der 13. Schwangerschaftswoche bis zur Geburt,

  • die Perinatalperiode von der 29. Schwangerschaftswoche bis zum 7. Lebenstag,

  • die Neugeborenenperiode vom 1. bis zum 28. Lebenstag und -die Säuglingszeit bis zum Ende des 1. Lebensjahres.

Jede dieser Entwicklungsphasen hat ihre Besonderheiten in Diagnostik und Therapie. Durch die Chorionzottenbiopsie lassen sich im Einzelfall bereits mit 9–10 Schwangerschaftswochen (SSW) mittels biochemischer und molekulargenetischer Methoden monogene Erbkrankheiten sowie die wichtigsten Erbmerkmale auf Blutzellen und damit fetomaternale Inkompatibilitäten feststellen. In der Fetalperiode erlauben v. a. Sonographie, Doppleruntersuchung der fetalen Gefäße, Fruchtwasserpunktion (Amniozentese) und intrauterine Punktion der Nabelschnur (Kordozentese) eine frühzeitige, differenzierte Diagnostik und Therapie.

Die transfusionsmedizinischen Erfordernisse in der Neonatalperiode stehen häufig in unmittelbarem Zusammenhang mit Frühgeburt und/oder pathologischen Geburtsprozessen, z. B. Blutungen aus Nabelschnur und Plazenta oder geburtstraumatische Blutungen. Fetomaternale oder fetofetale (Zwilling-zu-Zwilling-) Transfusionen können Volumenmangelzustände und Anämien auslösen. Zu Massivtransfusionen im Neugeborenenalter kommt es bei Austauschtransfusionen und extrakorporalen Kreisläufen (z. B. extrakorporale Membranoxygenation [ECMO] bei Atemversagen oder operativen Eingriffen).

Immunologisch bedingte Hämozytopenien als Folge von Allound Autoimmunprozessen während der Schwangerschaft oder septisch bedingte Blutzellschädigungen können substitutionsbedürftig werden. In seltenen Fällen bedürfen kongenitale Bluterkrankungen (z. B. hyporegenerative Anämien [Fanconi-Anämie], Thrombozytopenien [Glanzmann-Thrombasthenie], Agranulozytosen [M. Kostmann] und kombinierte Immundefektsyndrome) einer transfusionsmedizinischen Behandlung.

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  1. DRK-Blutspendedienst NSTOB, Institut für Transfusionsmedizin Dessau, Altener Damm 50, 06847, Dessau

    H. Kroll

  2. Zentrum für Kinder- u. Jugendmedizin, Universitätsklinikum Gießen u. Marburg GmbH, Standort Marburg Baldingerstr, 35033, Marburg

    Dr. R. F. Maier

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    Volker Kiefel

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Kroll, H., Maier, R.F. (2010). Perinatale und pädiatrische Transfusionsmedizin. In: Kiefel, V., Mueller-Eckhardt, C. (eds) Transfusionsmedizin und Immunhämatologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-12765-6_31

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