[Therapy using blood components. Prerequisites, indications and clinical use].

The therapeutic benefit of blood components for specific substitution and volume replacement has been recognized for more than ten years. The increasing demand for blood and blood products, especially for albumin in connection with an only moderate growth of the base of blood donors has promoted the idea of a more efficient utilization of blood by specific replacement with blood components. The component therapy has reduced the side effects and improved the efficacy of blood transfusion and last but not least has led to a positive cost-effectiveness. Our clinical management of blood transfusion with a nearly complete use of components in surgical patients is presented. Particularly, the therapeutic strategy for massive transfusions by component therapy is discussed. In face of the technical and logistic problems, a transfusion schedule was developed which outlines the nearly exclusive therapeutic use of components. It applies with modifications and adjustment to the critical parameters to all cases of rapid and massive blood loss. In addition, diagnostic and therapeutic strategies are considered to preserve hemostasis or correct occurring hemostatic defects and to prevent thrombo-embolic events.