Perinatale und pädiatrische Transfusionsmedizin

  • H. Kroll
  • R. F. Maier

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,

  • das Neugeborenenalter vom 1. bis zum 28. Lebenstag und

  • die Säuglingszeit bis zum Ende des 1. Lebensjahres.

Jede dieser Perioden hat ihre Besonderheiten in Diagnostik und Therapie. Durch die Chorionzottenbiopsie lassen sich bereits in der 8.-9. Gestationswoche mittels biochemischer und molekularbiologischer Methoden zahireiche Erbkrankheiten, aber auch die wichtigsten Erbmerkmale auf Blutzellen und damit fetomaternale Inkompatibilitaten feststellen. In der Fetalperiode sind es v.a. die Möglichkeiten der Sonographie, der Fruchtwasserpunktion (Amniozentese) und der intrauterinen Punktion der Nabelschnur (Kordozentese), die eine frühzeitige, differenzierte Diagnostik und Therapie ermöglichen.

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

Immunologisch bedingte Hämozytopenien als Folge von Allo- und Autoimmunprozessen während der Schwangerschaft oder septisch bedingte Blutzellschädigungen können substitutionsbedürftig werden. In seltenen Fällen sind es kongenitale oder erbliche Bluterkrankungen [z. B. hyporegenerative Anämien (Fanconi), Thrombozytopenien, Agranulozytosen (M. Kostmann) und kombinierte Immundefektsyndrome], die transfusionsmedizinischer Behandlung bedürfen.

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© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • H. Kroll
  • R. F. Maier

There are no affiliations available

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