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Querschnittleitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten: Humanalbumin

Empfehlungen des wissenschaftlichen Beirats der Bundesärztekammer

Guidelines on therapy with blood components and plasma derivatives: human albumin

Recommendations of the scientific advisory board of the Medical Council

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An Erratum to this article was published on 01 December 2011

Zusammenfassung

Humanalbumin (HA) ist mit Abstand die teuerste Möglichkeit zum Ausgleich eines Volumenmangels. Darüberhinaus kommt HA vielfach zum Ausgleich einer Hypoalbuminämie zum Einsatz. Angesichts zunehmend eingeschränkter finanzieller Resourcen stellt sich die Frage, inwieweit die Gabe von HA heute noch zu rechtfertigen ist. Der Beirat der Bundesärztekammer hat dazu kürzlich Querschnittleitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten herausgegeben. Die Gabe von HA zur Therapie des Volumenmangels im perioperativen Bereich und beim Intensivpatienten wird generell nicht empfohlen, sondern es wird auf moderne kolloidale Volumenersatzmittel als sichere Alternativen verwiesen. Auch zum Volumenersatz bei Kindern wird HA nicht als Therapie der ersten Wahl empfohlen, da deutlich preisgünstigere Alternativen bestehen. Der Ausgleich einer Hypoalbuminämie mithilfe von HA in der Intensivmedizin wird ebenfalls nicht generell empfohlen. Ausnahmen hierzu könnten Patienten mit Leberzirrhose, spontan-bakterieller Peritonitis und ausgeprägter Aszitesentlastung sein, obwohl Vergleiche mit modernen kolloidalen Volumenersatzmitteln hierzu fehlen. Humanalbumin zur Verbesserung der Transportkapazität von Medikamenten und als Radikalenfänger bzw. zur Bindung toxischer Substanzen wird nicht empfohlen. Zusammenfassend lässt sich feststellen, dass gemäß den Empfehlungen des wissenschaftlichen Beirats der Bundesärztekammer die Gabe von HA sehr sorgsam zu überdenken ist.

Abstract

Human albumin (HA) is by far the most expensive option for volume replacement and correction of hypoalbuminemia but is still widely used. The value of HA in the clinical setting continues to be controversial and it remains unclear whether there is still a place for using such a high-priced substance in the present cost-consciousness climate. Thus the Medical Council has presented some recommendations with regard to blood and plasma products including HA. There appear to be no indications for HA to correct hypovolemia either perioperatively or in the intensive care setting including children and patients undergoing cardiac or liver surgery. For maintaining colloid oncotic pressure (COP) cheaper modern synthetic colloids can be alternatively given and the value of HA for correcting hypoalbuminemia is also not clearly justified. Some small uncontrolled studies have shown that only patients with liver cirrhosis, spontaneous bacterial peritonitis and massive ascites drainage may profit from HA. Theoretical benefits such as oxygen radical scavenging or binding of toxic substances are no indications for using HA as benefical clinical consequences have not yet been demonstrated. Experimental data from cell lines or animals must be viewed with skepticism because they do not mimic the clinical setting. According to the recommendations of the scientific advisory board of the Medical Council the use of HA should be considered very cautiously.

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Der korrespondierende Autor weist auf folgende Beziehung/en hin: B. Braun, Fresenius-Kabi, Edwards, Baxter.

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  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland

    J. Boldt

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00101-011-1965-1

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Boldt, J. Querschnittleitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten: Humanalbumin. Anaesthesist 59, 566–574 (2010). https://doi.org/10.1007/s00101-010-1734-6

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