Transfusi darah

7,687 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,687
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
200
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Transfusi darah

  1. 1. TRANSFUSI DARAH
  2. 2. REAKSI REAKSI TRANSFUSI DARAH• Bila dilaksanakan pemeriksaan laboratorium pra- transfusi darah, mayoritas transfusi darah tidak memberikan efek samping ke pada pasien• Namun, kadang kadang timbul reaksi pada pasien, walaupun pemeriksaan laboratorium pra-transfusi darah telah dilaksanakan dan hasilnya “COMPATIBLE” (= cocok antara darah resipien dan donor)• Reaksi: reaksi RINGAN (suhu meningkat, sakit kepala) s/d BERAT (reaksi hemolisis), bahkan dapat meninggal
  3. 3. KOMPLIKASI TRANSFUSI DARAH• Komplikasi LOKAL: - kegagalan memperoleh akses vena - fiksasi vena tidak baik - masalah ditempat tusukan - vena pecah saat ditusuk, dll• Komplikasi UMUM: - reaksi reaksi transfusi - penularan/transmisi penyakit infeksi - sensitisasi imunologis - kemokromatosis
  4. 4. REPORTING of SERIOUS HAZARDS of TRANSFUSION (SHOT)• Suspected or confirmed transfusion – transmitted infection (bacterial, viral, etc)• All instances where blood intended for one patient is given to another• Immediate or delayed haemolysis• Post – transfusion purpura• Transfusion – associated graft-versus-host disease• Transfusion-related acute lung injury
  5. 5. CLERICAL ERROR• Kesalahan administrasi  kesalahan manusia
  6. 6. REAKSI TRANSFUSI DARAH• Reaksi Tranfusi Darah AKUT: hemolitik, panas, alergi, hipervolume, sepsis bakteria, lung injury, dll• Reaksi Transfusi Darah LAMBAT
  7. 7. REAKSI REAKSI TRANSFUSI DARAH• Yang paling sering timbul: - reaksi febris - reaksi alergi - reaksi hemolitik
  8. 8. REAKSI FEBRIS• Nyeri kepala  menggigil dan gemetar tiba tiba  suhu meningkat• Reaksi jarang berat• Berespon terhadap pengobatan
  9. 9. REAKSI ALERGI• Reaksi alergi berat (anafilaksis): jarang• Urtikaria kulit, bronkospasme moderat, edema larings: respon cepat terhadap pengobatan
  10. 10. REAKSI HEMOLITIK• REAKSI YANG PALING BERAT• Diawali oleh reaksi: - antibodi dalam serum pasien >< antigen corresponding pada eritrosit donor - antibodi dalam plasma donor >< antigen corresponding pada eritrosit pasien• Reaksi hemolitik: - intravaskular - ekstravaskular
  11. 11. REAKSI HEMOLITIK• REAKSI INTRAVASKULAR: - hemolisis dalam sirkulasi darah - jaundice dan hemogolobinemia - antibodi IgM - paling bahaya anti-A dan anti-B spesifik dari sistem ABO - fatal  akibat perdarahan tidak terkontrol dan gagal ginjal
  12. 12. REAKSI HEMOLITIK• REAKSI EKSTRAVASKULAR: - jarang sehebat reaksi intravaskular - reaksi fatal jarang - disebabkan antibodi IgG  destruksi eritrosit via makrofag - menimbulkan penurunan tiba triba kadar Hb s/d 10 hari pasca transfusi
  13. 13. REAKSI REAKSI TRANSFUSI DARAH• Bila dilaksanakan pemeriksaan laboratorium pra- transfusi darah, mayoritas transfusi darah tidak memberikan efek samping ke pada pasien• Namun, kadang kadang timbul reaksi pada pasien, walaupun pemeriksaan laboratorium pra-transfusi darah telah dilaksanakan dan hasilnya “COMPATIBLE” (= cocok antara darah resipien dan donor)• Reaksi: reaksi RINGAN (suhu meningkat, sakit kepala) s/d BERAT (reaksi hemolisis), bahkan dapat meninggal
  14. 14. GOLONGAN DARAH• A,B, AB, O• Rhesus + / -• Golongan darah jarang
  15. 15. Sistem golongan darah eritrosit utama pada manusiaTahun Sistem Antigen utama Antibodi timbulditemukan pada eritrosit secara alamiah ABO H,A,B Selalu1901 MNSs M,N,S,s Tak1926 P P1,p Kadang – kadang1926 Rh D,C,E,c,e Tak1940 Lutheran (Lu) Lua.Lub Tak1945 Kell K,k,Kpa,Kpb,Kpc,Jsa,Jsb Tak1946 Lewis (Le) Lea,Leb Kadang – kadang1946 Duffy (Fy) Fya,Fyb Tak1950 Kidd (Jk) Jka,Jkb Tak1951 Diego (Di) Dia,Dib Tak1955 Cartwright (Yt) Yta,Ytb Tak1956 Xg Xga Tak1962 Dombrock (Do) Doa,Dob Tak1965 Colton (Co) Coa,Cob Tak1967 Scianna (Sc) Sc1,Sc2 Tak1974
  16. 16. Golongan darah ABOFenotip Genotip Antigen Antibodi Frekuensi eritrosit serum Kaukasia OrientalO OO H Anti-A 45 30 Anti-BA1 A1 A1 A + A1 Anti-B A1 O A1 A2 41 38A2 A2 A2 A+H Anti-B (Anti A1) A2 OB B + (H) Anti-A 11 22 BB BOA1 B A + A1 + B tidak ada A1 B 3 10A2 B A + B + (H) (Anti A1) A2 B
  17. 17. PEMERIKSAAN SEROLOGI GOLONGAN DARAH PRA TRANSFUSI• PEMERIKSAAN GOLONGAN DARAH ABO dan Rhesus pada PASIEN DAN DONOR• Pemeriksaan CROSSMATCHING (reaksi kecocokan silang)• PEMERIKSAAN GOLONGAN DARAH ABO, dari 2 arah: - Cell grouping: ada/tidaknya antigen A atau B pada permukaan eritrosit - Serum grouping (back typing): ada/tidaknya antibodi A, B, AB dalam serum/plasma• PEMERIKSAAN GOLONGAN DARAH RHESUS: - hanya antigen-D atau Du yang diperiksa pada eritrosit
  18. 18. Table 1. Blood Components and Plasma Derivatives (1)Component/Product Composition Volume IndicationsWhole Blood RBCs (approx. Hct 40%); plasma; 500 ml Increase both cell mass & plasma WBCs; platelets volume (WBCs & platelets not functional; plasma deficient in labile clotting Factors V and VIII)Red Blood Cells RBC (approx. Hct 75%); reduced 250 ml Increase red cell mass in symptom plasma, WBCs, and platelets atic anemia (WBCs & platelets not functional)Red Blood Cells, RBC (approx. Hct 60%); reduced 330 ml Increase red cell mass in symptomaticAdenine-Saline plasma, WBCs, and platelets; anemia (WBCs and platelets notAdded 100 ml of additive solution functional)RBCs Leukocytes > 85% original volume of RBC; 225 ml Increased red cell mass; < 5 x 106 WBCsReduced (prepa- < 5 x 106 WBC; few platelets; to decrease the likelihood of febrile reac-red by filtration) minimal plasma tions, immunization to leukocytes (HLA) antigens) of CMV transmissionRBCs Washed RBCs (approx, Hct 75%); 180 ml Increase red cell mass; reduced risk of < 5 x 108 WBCs; no plasma allergic reactions to plasma proteinsRBCs Frozen; RBC (approx. Hct 75%); 180 ml Increased red cell mass; minimizeRBCs Deglycerolized < 5 x 108 WBCs; no platelets; febrile or allergic transfusion reaction; no plasma use for prolonged RBS blood storage (Continued)
  19. 19. Table 1. Blood Components and Plasma Derivatives (2)omponent/Product Composition Volume Indicationsarnulocytes Granulocytes (>1.0 x 1010 220 ml Provide granulocytes for selected patientsheresis PMN/unit); lymphocytes; with sepsis and severe neutropenia platelets (>2.0 x 1011/unit); (< 500 PMN/µL) some RBCsatelets Platelets (> 5.5 x 1010/unit); 300 ml Bleeding due to thrombocytopenia or RBC; WBCs; plasma thrombocytopathyatelets Pheresis Platelets (> 3 x 1011); 300 ml Same as platelets;l sometimes HLA RBCs; WBCs; plasma matchedatelets Leukocytes Platelets (as above);< 5 x 106 300 ml Same as platelets; < 5 x 106 WBCs toeduced WBCs per final dose of pooled decrease the likehood of febrile reactions, platelets alloimmunization to leukocytes (HLA antigens), or CMV transmissionFP; FFP Donor Plasma; anticoagulation factors; 220 ml Treatment of some coagulation disoetested plasma; complement (no platelets)olvent/detergent- eated plasma yoprecipitated Fibrinogen; Factors VIII and XIII;15 ml Deficiency of fibrinogen; Factor XIII;HF von Willebrand factor second choice in treatment of hemophilia A, von Willebrand’s disease (Continued)
  20. 20. Table 1. Blood Components and Plasma DerivativesComponent/Product Composition Volume IndicationsFactor VIII Factor VIII; trace amount of other 25 ml Hemophilia A (Factor VIII deficiency);(consentraes; plasma proteins (products vary Willebrand’s disease (off-label use forRecombinant human in purity) selected products only)Factor VIII)Factor IX (concen- Factor IX; trace amount of other 25 ml Hemophilia B (Factor IX deficiency)Trates, recombi plasma proteins (products varyNant human in purity)Factor IX)Albumin/PPF Albumin, some α-, ß-globulins (5%); Volume expansion (25%)Immune Globulin IgG antibodies preparations for varies Treatment of hypo-or agammaglobuline- IV and / or IM use mia; disease prophylaxis; autoimune thrombocytopenia (IV only)Rh Immune IgG anti-D; preparations for IV 1 ml Prevention of hemolytic disease of theGlobulin and/or IM use newborn due to D antigen; treatment of autoimmune thrombocytopeniaAntithrombin Antithrombin; trace amount of 10 ml Treatment of antithrombin deficiency other plasma proteinsRBCs = red blood cells; Hct = hematocrit; WBCs = white blood cells; CMV = cytomegalovirus; PMN = polymorphonuclear cells;FFP = fresh frozen plasma; PPF = plasma protein fraction; IV = intravenous; IM = intramuscular
  21. 21. PEMBERIAN TRANSFUSI DARAH pada PASIEN• Nilai ulang: - check list pelaksanaan transfusi darah - golongan darah pasien = donor ? (tanyakan/peneng) - identitas pasien tepat ? - identitas donor dan gol drh donor  label merah muda, putih, biru muda, kuning - awasi selama dan setelah transfusi (tanggung jawab dokter) - awasi reaksi transfusi darah
  22. 22. Indikasi Penggantian faktor – faktor Hemostatik pada Pasien Trauma -Tentukan status koagulasi pasien, bila mungkin dengan tes laboratorium yang tepat - Pedoman klinis : * luas dan lokasi perlukaan * lama renjatan berlangsung * respon terhadap resusitasi awal * risiko komplikasi, misalnya perdarahan intrakanial - Ganti komponen darah untuk memperbaiki kelianan spesifik - Pedoman untuk komponen darah spesifik : Berikan transfusi  * trombosit : bila jumlah trombosit < 80 – 100 x 109/L * FFP : bila masa protrombin / masa tromboplastin parsial > 1,5 x normal * Kriopresipitat : bila kadar fibrinogen < 10 g/L
  23. 23. TRANSFUSI TROMBOSIT• Trombosit disimpan dalam kondisi digoyang terus (Reciprocal agitator), pada suhu kamar (20 C Celcius)• Harus segera diberikan (tidak boleh disimpan di kulkas/ di ruangan)• Kecepatan cepat• Gunakan infus set khusus (jangan menggunkan set transfusi darah merah) = Platelet Administration Set = TERUFUSSION (Terumo®)
  24. 24. KEBUTUHAN TROMBOSIT• Trombosit: - dosis umumnya: 1 unit per 10 kg BB (5-7 unit untuk orang dewasa) - 1 unit meningkatkan 5000/mm3 (dewasa 70 kg) - ABO-Rh typing saja, tak perlu cross match, kecuali pada keadaan tertentu
  25. 25. Corrected platelet increment (CI) = (P1 – P0) x BSA x n-1P1 = platelet count before transfusion (109/l)P0 = platelet count 1 hour after transfusion (109/l)BSA = recipient’s body surface area, m2N = number of units of platelet concentrates transfused, each > 0,55 x 1011A corrected platelet increment 1 hour after administration that isHigher than 7,5 x 109/l indicates a successful transfusion of platelets
  26. 26. KEBUTUHAN PLASMA/FFP• Dosis bergantung kondisi klinis dan penyakit dasarnya• Coagulation factor replacement: 10 – 20 ml/kg BB (= 4-6 unit pd dewasa)• Dosis ini diharapkan dapat meningkatkan faktor koagulasi 20 % segera setelah transfusi• Plasma yang dicairkan (suhu 30 - 37º C) harus segera ditransfusikan• ABO-Rh typing saja (tak perlu cross match)
  27. 27. Content of Cryoprecipitate80 to 120 units of Factor VIII : C (procoagulant activity)250 mg fibrinogen20% to 30% of the factor XIII in the original unit40% to 70% of the factor VIII : VWF (von Willebrand factor) in theOriginal unit
  28. 28. KEBUTUHAN KRIOPRESIPITAT• Diencerkan pada suhu 30 – 37 C• 1 unit akan meningkatkan fibrinogen 5 mg/dl pada dewasa• Target hemostasis level: fibrinogen > 100 mg %• Segera transfusikan dalam 4 jam• Dosis untuk pasien hemofilia: rumus
  29. 29. Table 5. Acute Transfusion Reactions (1)Type Sign and Symptoms Usual Cause Treatment PreventionIntravascular Hemoglobinemia and ABO incompatibility Stop transfusion; Avoid clericalhemolytic hemoglobinuria, fever, (clerical error) or other hydrate, support errors; ensure(immune) chills, anxiety, shock, DIC, complement – fixing blood pressure & proper sample dyspnea, chest pain, antibody causing respiration; induce & recipient flank pain, oliguria antigen – antibody diuresis; treat shock identification incompatibility and DIC, if presentExtravascular Fever, malaise, indirect IgG Monitor Ht, Avoid clericalHemolytic hiperbilirubinemia, non-complement- renal & hepatic error : ensure(immune) increased urine urobili- fixing antibody often function, coagulati proper sample nogen, falling hematocrit assoclated with on profile, no acute & recipient delayed hemolysis treatment generally identification requiredFebrile Fever, chill, rarely Antibodies to Stop transfusion; Pre transfusion hypotension leukocytes or plasma give antipyretic; antipyretic; protein; hemolysis; eg, acetaminophen leukocyte- passive cytokines ; for rigors reduced blood infusion; sepsis. Use meperidine 25- if recurrent Commonly due to 50 mg IV or IM patient’s underlying condition (continued)
  30. 30. Table 5. Acute Transfusion Reactions (2)Type Sign and Symptoms Usual Cause Treatment PreventionAllergic (mild Urticaria (hives), rarely Antibodies to plasma Stop transfusion; Pre-transfusionTo severe) hypotension or anaphy- proteins; rarely anti- give; antihistamine antihitamine; laxis bodies to IgA (PO or IM); if severe, washed RBC epinephrine and/or components, if steroids recurrent or severe checkpre- transfusion IgA levels in patients with a history of of anaphylaxis to transfusionHypervolemic Dyspnea, hypertension Too rapid and/or Induced diuresis; Avoid rapid or pulmonary edema, excessive blood phlebotomy; excessive cardiac arrhytmias transfusion support cardio- transfusion respiratory system as needed (continued)
  31. 31. Table 5. Acute Transfusion Reactions (3)Type Sign and Symptoms Usual Cause Treatment PreventionTransfusion- Dyspnea, fever HLA or leukocyte Support blood Leukocyte-reducedrelated acute pulmonary edema, antibodies; usually pressure and RBCs if recipientlung injuri hypotension, normal donor antibody respiration (may has the antibody;(TRALI) pulmonary capillary transfused with require intubation) notify transfusion wedge pressure plasma in compo service to quaran- nents tine remaining components from donorBacterial Rigors, chills, fever, Contaminated Stop transfusion; Care in bloodsepsis shock blood component support blood collection and pressure; culture storage; careful patient and blood attention to arm- unit; give antibiotics preparation for ; notify blood trans- phlebotomy fusion serviceDIC = disseminated intravascular coagulation; IV = intravenous; IM = intramuscular; PO = by mouth;RBC = red blood cells
  32. 32. Table 4. Workup of an Acute Transfusion ReactionIf an acute transfusion reaction occurs :1. Stop blood component transfusion immediately2. Verify the correct unit was given to the correct patient3. Maintain IV access and ensure adequate urine output with an appropriate crystalloid or colloid solution4. Maintain blood pressure, pulse5. Maintain adequate ventilation6. Notify attending physician and blood bank7. Obtain blood / urine for transfusion reaction workup8. Send blood bag and administration set to blood transfusion service immediately9. Blood bank performs workup of suspected transfusion reaction at follows : a. Check paper work to ensure correct blood component was transfused to the right patient b. Evaluate plasma for hemoglobinemia c. Perform direct antiglobulin set d. Repeat other serologic testing as needed (ABO/RH)If intravascular hemolytic reaction in confirmed10. Monitor renal status (BUN, creatinine)11. Initiate a diuresis12. Analyze urine for hemoglobinuria13. Monitor coagulation status (prothrombin time, partial tromboplastin time, fibrinogen, platelet count)14. Monitor for sign of hemolysis (lactate dehydrogenase, bilirubin, haptoglobin, plasma hemoglobin)15. Repeat compatibility testing (cross match)16. If sepsis is suspected, culture unit and patients, and treat as appropiate Adapted from snyder EL. Transfusion reaction. In : Hoffman R, Benz. EF Jr, Shattil SJ, et al. Hematology : Basic Principle and practice, 2nd ed. Ney York : Chruchill Livingstone, 1995 ; 2045-53

×