1<br />Reaksi Transfusi<br />Tutor Imunologi Putaran I<br />Bastiana/Siswanto Darmadi<br />Departemen Patologi Klinik<br /...
2<br />Hiper / Hipotensi<br />Takikardia<br />Sakit kepala<br />demam <br />Diare<br />Urtikaria <br />menggigil<br />Hemo...
3<br />Reaksi transfusi<br />3<br />1<br />2<br />Komponen darah<br />–Platelets <br />   (FNHTR,<br />   kontaminasi<br /...
4<br />Klasifikasi Reaksi transfusi<br />
5<br />Reaksi Transfusi Segera dan Tertunda<br />
6<br />Reaksi Transfusi Segera dan Tertunda<br />
7<br />
8<br />
9<br />Topik Reaksi Transfusi<br />1<br />Reaksi Transfusi hemolitik akut<br />2<br />Reaksi Transfusi demam non hemolitik...
10<br />Hemolitik Akut = 1:250.000-600.000<br /> demam non hemolitik = 1:200<br />RT Alergi = 1:33.000<br />RT Anafilaksis...
11<br />Data UTD PMI  Surabaya<br />20 orang (dewasa 17, anak-anak 3)<br />
12<br />Reaksi transfusi hemolitik akut     <br />• Inkompatibilitas  SDM donor &    plasma resipien, terutama ABO<br />• ...
13<br />
14<br />Klasifikasi RTHA <br />Non Imunologik:<br />- SDM rusak sebelum transfusi<br />Imunologik:<br /><ul><li>Ig M antiA...
15<br />Investigasi lab RTHA<br />1<br />2<br />3<br />Inspeksi Visual<br /><ul><li>Warna plasma</li></ul> resipien:merah<...
16<br />Analisis Laboratorik RTHA<br />
17<br />Prinsip pemeriksaan ABO<br />Reaksi aglutinasi spesifik antara antigen pada SDM dan antibodi Ig M pada serum.<br /...
18<br />Hasil pemeriksaan dengan melihat aglutinasi (+) atau (-)<br />
19<br />Penentuan golongan darah Rhesus<br /><ul><li>yang ditentukan hanya antigen D (Rho)
menggunakan anti D (anti Rho )</li></li></ul><li>20<br />Dua macam Reaksi Silang<br />Reaksi silang mayor<br />	serum pend...
21<br />Contoh Reaksi silang<br />Contoh :<br />		Donor A			Resipien B<br />Reaksi silang mayor<br />	sel darah merah dono...
22<br />Penyebab Reaksi silang mayor +<br />1.Terjadi kesalahan penentuan golongan darah ABO dari penderita atau donor<br ...
23<br />Penyebab Reaksi silang mayor +<br />4.Serum penderita yang abnormal <br /><ul><li>myeloma dan macro globulinemia
dextran atau plasma expander
antibodi terhadap albumin</li></ul>5.Sel darah merah telah tercoated IgG dan atau komplemen.<br />6.Kontaminasi sampel ole...
24<br /> Prinsip Tes AHG (Anti Human Globulin)<br /><ul><li>SDM yang telah disensitisasi dengan Ab inkomplet (IgG) menunju...
Sensitisasi bisa terjadi secara in vivo atau in vitro (setelah inkubasi dengan serum yang berisi antibodi).</li></li></ul>...
26<br />Reaksi transfusi demam non hemolitik<br />• Peningkatan suhu>1°C di atas baseline<br />• Penyebab:<br />– Antibodi...
27<br />1<br />2<br />3<br />Inspeksi Visual<br /><ul><li>Warna plasma</li></ul> resipien : normal<br /><ul><li>Warna urin...
28<br />Reaksi transfusi alergi<br />• terjadi 1-3%<br />• Terbanyak karena produk plasma<br />• Reaksi ringan:<br />   – ...
29<br />Reaksi transfusi anafilaksis<br />• 1:20 000 – 50 000<br />• Terjadi pada awal transfusi<br />• Gejala pada sistem...
30<br />1<br />2<br />3<br />Plasma/urine merah, Ketidaksesuaian go darah ABO pre dan paska , AHG direk(+)  mengekslusi D...
31<br />Transfusion reaction acute lung injury<br />• ARDS ( Acute Respiratory Distress Syndrome) dalam 1-6 jam<br />   – ...
32<br />Investigasi lab TRALI<br />1<br />2<br />3<br />Pemeriksaan BNP edema paru TRALI atau edema paru pada RT kelebiha...
33<br />Reaksi transfusi kontaminasi bakteri<br />• Lebih sering terjadi pada produk trombosit  <br />   (karena disimpan ...
34<br />Reaksi transfusi kontaminasi bakteri <br />Onset cepat, tingkat mortalitas tinggi<br />Adanya bakteri pada darah t...
35<br />Sumber kontaminasi bakteri<br /><ul><li>Kontaminasi permukaan kulit
Tempat flebotomi
Bakteriemia dari donor
Kontainer dan alat sekali pakai
Lingkungan</li></li></ul><li>36<br />Bacterial species in platelets implicated in clinical sepsis<br />Compilation of data...
37<br />Perbedaan antara spesies penyebab morbiditas dan mortalitas  sepsis pada komponen trombosit<br />S. epidermidis le...
38<br />Organisme penyebab sepsis pada produk trombosit<br />Hampir 30% adalah flora normal kulit<br /> Hampir 56% adalah ...
39<br />1<br />2<br />3<br />Inspeksi visual<br />-perubahan warna, <br />-penggumpalan<br /> pada sediaan <br /> darah/tr...
40<br />Skema Pemeriksaan Fisik  Reaksi Transfusi<br />
41<br />Lanjutan skema…(2)<br />
42<br />Lanjutan skema…(3)<br />
43<br />Tata Cara Pengiriman Sampel Darah ke Laboratorium PMI Pusat (PUTDP)<br /> untuk keperluan Penelusuran antigen eri...
44<br />Management of severe acute reaction<br />Symptoms/Signs of Acute Transfusion Reaction<br />Fever, chills, tachycar...
45<br />Continued from previous slide<br />Haemolytic reaction/bacterial infection of unit<br />Take down unit and giving ...
46<br />Thank You !<br />
47<br />Kasus<br />Laki-laki,  Tuan A, 55 tahun<br />MRS: <br />persiapan operasi Ca   abdomen. <br />Riwayat transfusi se...
48<br />Perawatan Rs<br />Hb saat mrs: 10 g/dL <br />Gol darahPx: O-Rh(+), Hasil skrining Ab (-)<br />Permintaan darah unt...
49<br />Temuan Laboratorium<br />Hasil sampel darah paska transfusi dari bank darah:<br />Uji ulang pemeriksaan spesimen d...
50<br />Clerical Checks<br />Clerical checks dilakukan di bank darah dan ruang operasi.<br />Hasil temuan:<br />   unit da...
51<br />Investigasi laboratorium<br />Tes DAT: negatif, menunjukkan telah terjadi destruksi cepat dari SDM inkompatibel ya...
52<br />Kesimpulan<br />Px mengalami reaksi transfusi hemolitik imun akut  disebabkan inkompatibilitas ABO<br />
53<br />Thank You !<br />
54<br />Prosedur DAT<br />Siapkan tabung 2 buah untuk tes dan kontrol<br />Isi masing-masing dengan 1 tetes suspensi SDM 3...
55<br />Prosedur IAT<br />Masukkan 2-4 tetes serum yang diperiksa ke tabung lalu tambahkan1 tetes % suspensi sel darah mer...
56<br />Deteksi Antibodi<br />Memeriksa sampel serumresipien terhadapsel skrining yang telah dipilih untuk mendeteksi Ab y...
57<br />Interpretasi Tes Deteksi Antibodi, Reaksi silang<br />Deteksi Ab(-), Reaksi silang(-):<br />   Tidak berarti bahwa...
58<br />
59<br />Investigations of transfusion reaction are necessary for :<br />Diagnosis<br />Selection of appropriate therapy<br...
60<br />5. Question related to the transfusion:<br />	Amount of blood transfused to cause the reaction.<br />	How fast , h...
61<br />Laboratory investigation outline of transfusion reaction.<br />Immediate procedures<br /><ul><li>Clerical checks.
Visual inspection of serum and plasma for free hemoglobin ( pre and post transfusion )
Direct anti – globulin test. ( post transfusion EDTA sample )</li></li></ul><li>62<br />2. As recquired procedures<br /><u...
Major compatibility testing , pre and post transfusion
Antibody screening test , pre and post transfusion
Alloantibody identification
Antigen typings
Free hemoglobin in first voidedurine post transfusion
Unconjugated bilirubin 5 – 7 hours post transfusion.</li></li></ul><li>63<br />3. Extended procedures<br /><ul><li>Gram st...
Quantitative serum Hemoglobin.
Serum Haptoglobin , pre and post transfusion
Peripheral blood film.
Coagulation and renal output study
Urine hemosiderin</li></li></ul><li>64<br />Sumber infeksi (Kontaminasi bakteri)<br />Infeksi dari darah simpan sangat jar...
65<br />Bacterial Detection Options in Platelet Products<br />Visual examination for discoloration, clumping or abnormal m...
66<br />Bacterial Detection Options in Platelet Products<br />Visual Examination<br />Inspect product prior to transfusion...
67<br />Swirling<br />Alignment with flow<br />SENSITIVITY: 75%<br />SPECIFICITY: 95%<br />No alignment with flow<br />Low...
68<br />Bacterial Detection Options in Platelet Products<br />Microscopic Methods<br />Gram Stain or Acridine Orange prefe...
69<br />Bacterial Detection Options                 in Platelet Products<br /> Measuring Biochemical Changes<br />Measure ...
70<br />Detecting Bacteria in Platelets:<br />Biochemical Changes<br />Glucose, % Day 0<br />-2 SD<br />Storage Time, d<br...
71<br />Chemical Tests - Dipsticks<br />Must be performed immediately before issue because of its<br />relative insensitiv...
72<br />Bacterial Detection Options in Platelet Products<br />Blood Culture Methods<br />Two methodologies presently appro...
73<br />Bacterial Detection Options in Platelet Products<br />bioMeriuex BacT/Alert System<br />Detects bacterial growth i...
74<br />Bacterial Detection Options in Platelet Products<br />Pall Biomedical BDS System<br />Detects bacterial contaminat...
75<br />Detecting Bacteria in Platelets:<br />Detection of Growth by O2 Consumption<br />Pall BDS system<br />Measure %O2<...
76<br />Bacterial Contamination of PlateletsPrevention and Detection Options<br />Donor screening – not feasible except fo...
77<br />Practical Application of Culturing <br />in a Transfusion Service Laboratory<br />Aubuchon, Dartmouth<br />Experie...
78<br />Bacterial Detection Options in Platelet Products<br />Limitations of Blood Culture Methods<br />Early sampling/tes...
79<br />Bacterial Detection Options in Platelet Products<br />Limitations of Blood Culture Methods<br />Both options requi...
80<br />Bacterial Detection Options in Platelet Products<br />Limitations of Blood Culture Methods<br />Need to balance th...
81<br />Bacterial Contamination in Transfusable Blood Products<br />AABB Guidance<br />Association Bulletin #03-07 issued ...
82<br />AABB Association Bulletin #03-07May 16, 2003<br />	Methods to Limit Contamination:<br />Careful phlebotomy – No gr...
83<br />AABB Association Bulletin #03-07May 16, 2003<br />	Methods to Detect Contamination:<br />Culture methods optimal. ...
84<br />Contoh pemeriksaan identifikasi Ab dengan gelcard (serascan Diana)<br />
85<br />Frekuensi Reaksi Transfusi akut<br />USA<br />Acute hemolytic, immune mediated (fatal) - 1 case per 250,000-600,00...
86<br />Investigasi lab RTHA<br />Inspeksi visual plasma resipien <br /><ul><li>sampel vena dengan antikoagulan disentrifu...
Warna merah dpt timbul meski baru bbrp ml darah inkompatibel yg ditransfusikan</li></ul>Inspeksi visual urine resipien: me...
87<br />Febrile transfusion reaction<br />•>1°C rise in temp and >38°C during <br />transfusion or within 4 hours<br />• P...
88<br />Febrile transfusion reaction<br />Management<br />1. Stop transfusion <br />& maintain access with IV saline<br />...
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  1. 1. 1<br />Reaksi Transfusi<br />Tutor Imunologi Putaran I<br />Bastiana/Siswanto Darmadi<br />Departemen Patologi Klinik<br />FK UNAIR/RSUD DR. SOETOMO<br />29 Agustus 2008<br />
  2. 2. 2<br />Hiper / Hipotensi<br />Takikardia<br />Sakit kepala<br />demam <br />Diare<br />Urtikaria <br />menggigil<br />Hemoglobinuria<br />syok<br />Mual / muntah<br />Nyeri dada, perut, otot, tulang, punggung<br />Flushing<br />Cemas, gelisah, bingung<br />sesak/batuk<br />Reaksi transfusi<br />merasa tidak sehat<br />Satu atau lebih dari gejala tsb menunjukkan kemungkinan reaksi transfusi…<br />
  3. 3. 3<br />Reaksi transfusi<br />3<br />1<br />2<br />Komponen darah<br />–Platelets <br /> (FNHTR,<br /> kontaminasi<br /> bakteri)<br />– Plasma ( RT <br /> alergi)<br />Kecerobohan (clerical error)<br />–tidak mengikuti<br /> prosedur<br />Karakteristik Px<br />– Multipara atau<br /> multitransfusi<br /> (PTP, DHTR) <br />– defisiensi IgA<br /> (anafilaksis)<br />Faktor Penyebab<br />
  4. 4. 4<br />Klasifikasi Reaksi transfusi<br />
  5. 5. 5<br />Reaksi Transfusi Segera dan Tertunda<br />
  6. 6. 6<br />Reaksi Transfusi Segera dan Tertunda<br />
  7. 7. 7<br />
  8. 8. 8<br />
  9. 9. 9<br />Topik Reaksi Transfusi<br />1<br />Reaksi Transfusi hemolitik akut<br />2<br />Reaksi Transfusi demam non hemolitik<br />Reaksi Transfusi Alergi<br />3<br />Reaksi Transfusi Anafilaksis<br />4<br />5<br />TRALI (Transfusion Realated Acute Lung Injury)<br />6<br />Reaksi Transfusi Kontaminasi bakteri<br />
  10. 10. 10<br />Hemolitik Akut = 1:250.000-600.000<br /> demam non hemolitik = 1:200<br />RT Alergi = 1:33.000<br />RT Anafilaksis = 1: 20.000-50.000<br />TRALI (TR Acute Lung Injury) = 1:5000<br />RT Kontaminasi bakteri = 1:700<br />Frekuensi Reaksi transfusi<br />
  11. 11. 11<br />Data UTD PMI Surabaya<br />20 orang (dewasa 17, anak-anak 3)<br />
  12. 12. 12<br />Reaksi transfusi hemolitik akut <br />• Inkompatibilitas SDM donor & plasma resipien, terutama ABO<br />• Faktor penyebab utama: clerical error<br />• Insidens bervariasi:<br /> RTHA imun fatal= 1:250.000-600.000 <br /> RTHA imun non fatal= 1:6.000-33.000<br /> RTHA non imun= jarang<br />• Sering terjadi pada tahap awal transfusi<br />• Gejala/tanda: demam, menggigil, sakit punggung, hipotensi, urine warna merah (hemoglobinuria)<br />Tahap lanjut: Gagal ginjal akut, DIC <br />
  13. 13. 13<br />
  14. 14. 14<br />Klasifikasi RTHA <br />Non Imunologik:<br />- SDM rusak sebelum transfusi<br />Imunologik:<br /><ul><li>Ig M antiA, antiB, antiA,B </li></ul>-IgG,Rh,Kell,dll<br />RTHA<br />Hemolis ekstravaskularSelama trasfusi<br />• Umumnya anti D <br />• demam, menggigil<br />• Tidak diikuti dengan gagal ginjal<br />Hemolisis tertunda<br />• 7 hari kemudianr<br />• Demam, ikterus, <br />Insidens 1 / 4000<br />Hemolisis intravaskular<br />Segera<br />• Anti A, B<br />• Ansietas<br />• muntah, diare<br />• demam, menggigil, nyeri dada dan pingggang<br />• Circulatory collapse<br />•Hemoglobinemia, haemoglobinuria<br />Angka kematian 10%<br />
  15. 15. 15<br />Investigasi lab RTHA<br />1<br />2<br />3<br />Inspeksi Visual<br /><ul><li>Warna plasma</li></ul> resipien:merah<br /><ul><li>Warna urine</li></ul> resipien:merah<br />Uji ulang:<br /><ul><li>Golongan</li></ul> darah donor<br /><ul><li>Golongan</li></ul> darah resipien<br /> paska transfusi<br />Tes AHG direk :<br />RT karena ABO inkompatibel hasil tes AHG direk +<br />
  16. 16. 16<br />Analisis Laboratorik RTHA<br />
  17. 17. 17<br />Prinsip pemeriksaan ABO<br />Reaksi aglutinasi spesifik antara antigen pada SDM dan antibodi Ig M pada serum.<br /> Ada 2 cara:<br /> 1.Penggolongan ditentukan melalui pemeriksaan SDM individu dengan reagen golongan darah yang telah diketahui(anti A, antiB, antiA,B)<br /> 2.Pemeriksaan serum individu tersebut dengan sel A, sel B dan sel O yang telah diketahui.<br />
  18. 18. 18<br />Hasil pemeriksaan dengan melihat aglutinasi (+) atau (-)<br />
  19. 19. 19<br />Penentuan golongan darah Rhesus<br /><ul><li>yang ditentukan hanya antigen D (Rho)
  20. 20. menggunakan anti D (anti Rho )</li></li></ul><li>20<br />Dua macam Reaksi Silang<br />Reaksi silang mayor<br /> serum penderita + sel darah merah donor<br />Reaksi silang minor<br /> plasma donor + sel darah merah penderita<br />
  21. 21. 21<br />Contoh Reaksi silang<br />Contoh :<br /> Donor A Resipien B<br />Reaksi silang mayor<br /> sel darah merah donor + plasma resipien<br /> ag A anti A<br /> hasil +<br />Reaksi silang minor<br /> plasma donor + sel darah merah resipien<br /> anti B antigen B<br />hasil +<br />
  22. 22. 22<br />Penyebab Reaksi silang mayor +<br />1.Terjadi kesalahan penentuan golongan darah ABO dari penderita atau donor<br /> Penentuan gol. darah ABO harus segera diulang. <br />2.Ada allo antibodi dalam serum penderita yang bereaksi dengan antigen sel darah merah donor.<br />3.Ada oto antibodi dalam serum penderita yang bereaksi dengan antigen sel darah merah donor.<br />
  23. 23. 23<br />Penyebab Reaksi silang mayor +<br />4.Serum penderita yang abnormal <br /><ul><li>myeloma dan macro globulinemia
  24. 24. dextran atau plasma expander
  25. 25. antibodi terhadap albumin</li></ul>5.Sel darah merah telah tercoated IgG dan atau komplemen.<br />6.Kontaminasi sampel oleh bakteri, alat gelas yang kotor, fibrin clots, dan lain-lain.<br />
  26. 26. 24<br /> Prinsip Tes AHG (Anti Human Globulin)<br /><ul><li>SDM yang telah disensitisasi dengan Ab inkomplet (IgG) menunjukkan aglutinasi dengan penambahan AHG.
  27. 27. Sensitisasi bisa terjadi secara in vivo atau in vitro (setelah inkubasi dengan serum yang berisi antibodi).</li></li></ul><li>25<br />
  28. 28. 26<br />Reaksi transfusi demam non hemolitik<br />• Peningkatan suhu>1°C di atas baseline<br />• Penyebab:<br />– Antibodi resipien terhadap lekosit donor <br />– Zat Bioreaktif pada produk (darah) simpan<br />• Insidens 1:200 transfusi sel darah merah<br />• sampai 30% pada transfusi trombosit PRP <br /> • Penanganan: antipiretika dan produk minim lekosit<br />• DD :<br />– Kontaminasi bakteri<br />- Reaksi transfusi hemolitik<br />
  29. 29. 27<br />1<br />2<br />3<br />Inspeksi Visual<br /><ul><li>Warna plasma</li></ul> resipien : normal<br /><ul><li>Warna urine resipien:</li></ul> normal<br />Uji ulang tes ABO/RhD: cocok/tidak ada perbedaan <br />Tes AHG direk :negatif<br />Investigasi lab RT demam non hemolitik<br />
  30. 30. 28<br />Reaksi transfusi alergi<br />• terjadi 1-3%<br />• Terbanyak karena produk plasma<br />• Reaksi ringan:<br /> – Urtikaria tanpa gejala lain<br /> – Penanganan dengan antihistamin<br />• Reaksi lebih serius: <br /> – hypotensi dan sesak nafas(wheeze)<br /> – Penanganan seperti anafilaksis<br />
  31. 31. 29<br />Reaksi transfusi anafilaksis<br />• 1:20 000 – 50 000<br />• Terjadi pada awal transfusi<br />• Gejala pada sistem pernapasan-jantung, gastrointestinal, dan kulit. <br />• Stop transfusi<br />• Penanganan dengan resusitasi cairan, adrenalin/hidrocortison/antihistamin <br />• Pertimbangkan defisiensi IgA <br />
  32. 32. 30<br />1<br />2<br />3<br />Plasma/urine merah, Ketidaksesuaian go darah ABO pre dan paska , AHG direk(+)  mengekslusi Dx RT anafilaksis <br />Pemeriksaan anti IgA sampel serum/plasma resipien pre transfusi (+)Dx tegak<br />Pemeriksaan IgA sampel resipien sebelum transfusi mengekslusi Dx<br />Investigasi lab RT Anafilaksis<br />
  33. 33. 31<br />Transfusion reaction acute lung injury<br />• ARDS ( Acute Respiratory Distress Syndrome) dalam 1-6 jam<br /> – Resp distress, tachycardia, demam,<br /> hypotensi<br /> – Kabut ‘white out’ pada CXR (Chest-X<br /> Ray)<br />• Respiratory support - 80% pulih<br />• Ab donor terhadap netrofil atau HLA Antigen <br />
  34. 34. 32<br />Investigasi lab TRALI<br />1<br />2<br />3<br />Pemeriksaan BNP edema paru TRALI atau edema paru pada RT kelebihan cairan<br />Mengekslusi kemungkinan sepsis karena mempunyai gejala yang mirip<br />Mengekslusi reaksi hemolisis karena mempunyai gejala yang mirip<br />
  35. 35. 33<br />Reaksi transfusi kontaminasi bakteri<br />• Lebih sering terjadi pada produk trombosit <br /> (karena disimpan pada suhu ruang)<br />• 1:100 000 pada transfusi trombosit<br />• sumber: kontaminasi kulit atau bakteriemia pada donor<br />• Gejala: demam, menggigil, takikardia, dan hipotensi<br />• Penanganan: resusitasi cairan dan AB<br />
  36. 36. 34<br />Reaksi transfusi kontaminasi bakteri <br />Onset cepat, tingkat mortalitas tinggi<br />Adanya bakteri pada darah transfusi dapat menimbulkan reaksi panas pada resipien (ok pyrogen) atau manifestasi serius sepsis dan syok endotoksik.<br />Umumnya disebabkan endotoksin yang diproduksi bakteri yang mampu tumbuh pada temperatur dingin, spt Pseudomonas species, E. coli, Yersinia enterocolitica.<br />
  37. 37. 35<br />Sumber kontaminasi bakteri<br /><ul><li>Kontaminasi permukaan kulit
  38. 38. Tempat flebotomi
  39. 39. Bakteriemia dari donor
  40. 40. Kontainer dan alat sekali pakai
  41. 41. Lingkungan</li></li></ul><li>36<br />Bacterial species in platelets implicated in clinical sepsis<br />Compilation of data from Clin Micro Rev 1994; 7:290-302; Transfusion 2001;41:1493-99; www.shot.demon.co.uk/toc<br />n = 86<br />
  42. 42. 37<br />Perbedaan antara spesies penyebab morbiditas dan mortalitas sepsis pada komponen trombosit<br />S. epidermidis lebih jarang didapati pada sepsis yang fatal namun lebih sering pada reaksi sepsis <br />Klebsiella lebih sering menyebabkan sepsis yang fatal <br />Gram negatif berakibat lebih fatal (60%)daripada gram positif (40%); gram positives penyebab mayoritas dari reaksi sepsis (56%)<br />
  43. 43. 38<br />Organisme penyebab sepsis pada produk trombosit<br />Hampir 30% adalah flora normal kulit<br /> Hampir 56% adalah gram positif<br />Semua aerobik atau anerobik fakultatif<br />(A rare (single case) exception: Clostridium perfringens fatality from a pooled platelet unit Trans Med 1998;8:19-22)<br />
  44. 44. 39<br />1<br />2<br />3<br />Inspeksi visual<br />-perubahan warna, <br />-penggumpalan<br /> pada sediaan <br /> darah/trombosit<br />Kultur darah transfusi/Px untuk menegakkan diagnosa <br />Mengekslusi reaksi transfusi hemolitik karena mempunyai gejala yang mirip<br />Investigasi lab Kontaminasi bakteri<br />
  45. 45. 40<br />Skema Pemeriksaan Fisik Reaksi Transfusi<br />
  46. 46. 41<br />Lanjutan skema…(2)<br />
  47. 47. 42<br />Lanjutan skema…(3)<br />
  48. 48. 43<br />Tata Cara Pengiriman Sampel Darah ke Laboratorium PMI Pusat (PUTDP)<br /> untuk keperluan Penelusuran antigen eritrosit dan serum antibodi penderita.<br /><ul><li>5 ml darah penderita tanpa larutan</li></ul> pembeku darah<br /><ul><li> 5 ml darah penderita dengan larutan</li></ul> pembeku darah 0.7 ml (Larutan citras)<br /><ul><li>Dikirim melalui Bank Darah PMI (UTDC)</li></ul> setempat dengan identitas penderita<br /> dan problematik yang jelas.<br />
  49. 49. 44<br />Management of severe acute reaction<br />Symptoms/Signs of Acute Transfusion Reaction<br />Fever, chills, tachycardia, hyper or hypotension, collapse, rigors, flushing, urticaria, bone, muscle, chest and/or abdominal pain, shortness of breath, nausea, generally feeling unwell, respiratory distress<br />Stop the transfusion and call a doctor<br />Measure temperature, pulse, BP, respiratory rate, O2 saturation<br />Check the identity of recipient, the details on the unit and compatibility form<br />Febrile non-haemolytic transfusion reaction<br />If temp rise less than 1.5oC, the observations are stable and the patient is otherwise well give Paracetamol.Restart infusion at slower rate and observe more frequently<br />Mild<br />fever<br />Mild Allergic reaction<br />Give Chlorpheniramine 10mg slowly i.v. and restart the transfusion at a slower rate and observe more frequently.<br />Reaction involves mild fever or urticarial rash only?<br />Urticaria<br />No<br />Suspected ABO incompatibility?<br />Recheck pack and patient ID<br />Severe allergic reaction<br />Bronchospasm, angioedema, abdominal pain, hypotension. Discontinue transfusion.<br />Return intact to blood bank along with all other used/unused units. Give Chlopheniramine 10mg slowly i.v. Commence O2, give salbutamol nebuliser. If severe hypotension, give adrenaline 0.5 ml of 1 in 1000 (i.e. 0.5 mg) i.m. Clotted sample to transfusion laboratory. Saline wash future components.<br />Yes<br />ABO Incompatibility<br />Take down unit and giving set.<br />Return intact to blood bank. Commence I.V. saline infusion. Monitor urine output/catheterise. Maintain urine output at >100 mls/hr. Give frusemide if urine output falls/absent. Treat any DIC with appropraite blood components. Inform Hospital Transfusion Department immediately.<br />No<br />Yes<br />Severe Allergic Reaction?<br />No<br />Continued on next slide<br />
  50. 50. 45<br />Continued from previous slide<br />Haemolytic reaction/bacterial infection of unit<br />Take down unit and giving set. Return intact to blood bank with all other used/unused units. <br />Take blood cultures, repeat blood group / crossmatch / FBC, co ag screen, Biochemistry, urinanalysis.<br />Monitor urine output.<br />Commence broad spectrum antibiotics if suspected bacterial infection.<br />Commence oxygen and fluid support<br />Seek Haematological advice<br />Yes<br />Other Haemolytic reaction /bacterial contamination?<br />No<br />Acute dyspnoea/hypotension<br />Monitor blood gases<br />Perform CXR, measure CVP/Pulmonary capillary pressure<br />Raised CVP<br />Normal CVP<br />TRALI<br />Dyspnoea, chest x ray, “whiteout”. Discontinue transfusion. Give 100% Oxygen. Treat as ARDS – Ventilate if hypoxia indicates<br />Fluid Overload<br />STOP INFUSION<br />Give oxygen and Frusemide 40-80 mg i.v.<br />From: ‘Handbook of Transfusion <br /> Medicine 3rd Edition’.<br />© Crown Copyright material is reproduced with the permission of the Controller of HMSO and Queen’s printer for Scotland.<br />
  51. 51. 46<br />Thank You !<br />
  52. 52. 47<br />Kasus<br />Laki-laki, Tuan A, 55 tahun<br />MRS: <br />persiapan operasi Ca abdomen. <br />Riwayat transfusi sebelumnya: (-)<br />
  53. 53. 48<br />Perawatan Rs<br />Hb saat mrs: 10 g/dL <br />Gol darahPx: O-Rh(+), Hasil skrining Ab (-)<br />Permintaan darah untuk transfusi: 2 unit RBCs<br />Hasil crossmatched 2 unit darah tsb: kompatibel<br />Selama operasi, setelah menerima 2 unit darah tsb, Px mengalami perdarahan merembes pada tempat operasi(experienced oozing at the surgical site). <br />TD menurun :<br />120/70 mm Hg  80/40 mm Hg <br />(sebelum operasi) (sesudah transfusi)<br />Transfusi di stop, hipotensi coba diatasi<br /> Sampel Px lalu dikirim untuk pemeriksaan<br />
  54. 54. 49<br />Temuan Laboratorium<br />Hasil sampel darah paska transfusi dari bank darah:<br />Uji ulang pemeriksaan spesimen darah Px pre transfusi: O-Rh(+)<br />Spesimen paska transfusi: aglutinasi campuran ketika dites dengan antisera antiA<br />Kemungkinan telah terjadi reaksi imun hemolitik<br />
  55. 55. 50<br />Clerical Checks<br />Clerical checks dilakukan di bank darah dan ruang operasi.<br />Hasil temuan:<br /> unit darah yang diberikan kepada Px ternyata salah.<br /> Dua Px dengan nama yang sama menjalani operasi pada saat yang bersamaan. <br /> Unit darah diambil hanya dengan berdasarkan nama Px saja tanpa memeriksa no identifikasi RS Px. <br /> Unit darah yang diambil ternyata adalah golongan A-Rh(+).<br />
  56. 56. 51<br />Investigasi laboratorium<br />Tes DAT: negatif, menunjukkan telah terjadi destruksi cepat dari SDM inkompatibel yang ditransfusikan.<br />Skrining Ab pre transfusi and paska transfusi: negatif. <br />Crossmatch pada spesimen pretransfusi deangan donor original kompatibel.<br />Hemoglobinemia dan hemoglobinuria (+)<br />PXx mengalami koagulopati hemoragik dengan afibrogenemia. Trombosit menurun. FDP meningkat,<br />Px mengalami anuria. Proses perdarahan tidak teratasi. Px meninggal<br />Hasil Otopsi: Hemoglobin cast pada tubulus renal.<br />
  57. 57. 52<br />Kesimpulan<br />Px mengalami reaksi transfusi hemolitik imun akut disebabkan inkompatibilitas ABO<br />
  58. 58. 53<br />Thank You !<br />
  59. 59. 54<br />Prosedur DAT<br />Siapkan tabung 2 buah untuk tes dan kontrol<br />Isi masing-masing dengan 1 tetes suspensi SDM 3% yang akan dites<br />Cuci dengan salin 4 kali, lalu buang semua salin<br />Pada tabung tes tambahkan 1-2 tetes AHG, campur<br />Pada tabung kontrol tanbahkan 1-2 tetes bovine albumin dalam salin<br />Sentrifus kedua tabung pada 500 RCF selama 15-20 detik<br />Setelah disentrifus, tabung digoyang/dimiringkan beberapa kali, lalu baca aglutinasi secara makroskopis atau mikroskopis<br />Bila tidak terjadi aglutinasi inkubasi tabung tersebut selama 5 menit,ulangi tahap 6-7<br />Kontrol: pada semua tabung dengan hasil negatif tambahkan 1 tetes control cell, ulangi tahap 6-7. Hasil akan positif, berarti AHG masih berfungsi. Tabung kontrol seharusnya memberi hasil negatif, jika (+)berarti ada autoaglutinasi<br />
  60. 60. 55<br />Prosedur IAT<br />Masukkan 2-4 tetes serum yang diperiksa ke tabung lalu tambahkan1 tetes % suspensi sel darah merah yang sudah dicuci<br />Dicampur dan diinkubasi selama 30 menit pada waterbath dngan suhu 37 C<br />Disentrifus dengan kecepatan 500 RCF selama 15-20 detik <br />Setelah disentrifus, tabung digoyang/ dimiringkan beberapa kali lalu baca adanya aglutinasi<br />Bila tidak terjadi aglutinasi, cuci dengan Salin3-4 kali, buang sisa salin sampai habis<br />Tambahkan 1-2 tetes AHG, campur.<br />Ulangi prosedur 3-4<br />Kontrol: Pada tabung yang negatif tambahkan sel kontrol yang sudah disensitisasi dengan Ig G, campur. Ulangi prosedur 3-4. Jika hasil (+), berarti tes yang negatif tsb adalah benar. Jika hasil (-), maka tes harus diulang.<br />
  61. 61. 56<br />Deteksi Antibodi<br />Memeriksa sampel serumresipien terhadapsel skrining yang telah dipilih untuk mendeteksi Ab yang penting untuk klinis (misalnyamenyebabkan reaksi transfusi hemolitik, umur SDM yang ditransfusikan pendek,HDN)<br />Identifikasi Antibodi<br /> Dilakukan bila deteksi Ab positif. Pemeriksaan ini sering disebut dengan panel tes.<br />Cara deteksi Antibodi<br />Sama denganreaksi silang<br />Ada 3 fase:- suhu kamar, 37 C, dan Antiglobulin<br />Keterbatasan: tak dapat mendeteksi semua antibodi yang tak diharapkan <br />
  62. 62. 57<br />Interpretasi Tes Deteksi Antibodi, Reaksi silang<br />Deteksi Ab(-), Reaksi silang(-):<br /> Tidak berarti bahwa serum resipien/donor tak punya antibodi yang tak diharapkan. Ini berarti bahwa tes hanya negatif terhadap sel/antigen yang dipakai saja. <br />Deteksi Ab(+), Reaksi silang(+):<br /> Alloantibodi<br /> Auto antibodi<br />Deteksi Ab(-), Reaksi silang(+):<br /> Ab terhadap Ag yang tak terdapat dalam reagen SDM<br /> ABO inkompatibel (lihat apa ada kesalahan label,dll)<br /> SDM donor telah dicoated IgG/komplemen, sehingga reaksi silang hasilnya positif.<br />Deteksi Ab(+), Reaksi silang(-):<br /> Ada anti Le bH yang bereaksi dengan SDM O yang Le(a-,b+) pada semua reagen RBC<br /> SDM A1 atau A1B yang Le(a-,b+) tak bereaksi dengan anti Le bH<br />
  63. 63. 58<br />
  64. 64. 59<br />Investigations of transfusion reaction are necessary for :<br />Diagnosis<br />Selection of appropriate therapy<br />Transfusion management<br />Prevention of future transfusion reaction.<br />Investigations should include correlations of clinical data with <br />laboratory result .<br />Important clinical data :<br />Diagnosis<br />Medical history of pregnancies, transplant, and previous transfusion.<br />Current medication<br />Clinical signs and symptoms of the reaction.<br />
  65. 65. 60<br />5. Question related to the transfusion:<br /> Amount of blood transfused to cause the reaction.<br /> How fast , how long ?<br /> The use of blood warmer.<br /> Any filter used ? Other solutions.<br /> Any drugs given at the time of transfusion<br />
  66. 66. 61<br />Laboratory investigation outline of transfusion reaction.<br />Immediate procedures<br /><ul><li>Clerical checks.
  67. 67. Visual inspection of serum and plasma for free hemoglobin ( pre and post transfusion )
  68. 68. Direct anti – globulin test. ( post transfusion EDTA sample )</li></li></ul><li>62<br />2. As recquired procedures<br /><ul><li>ABO grouping and RH typing, pre and post transfusion
  69. 69. Major compatibility testing , pre and post transfusion
  70. 70. Antibody screening test , pre and post transfusion
  71. 71. Alloantibody identification
  72. 72. Antigen typings
  73. 73. Free hemoglobin in first voidedurine post transfusion
  74. 74. Unconjugated bilirubin 5 – 7 hours post transfusion.</li></li></ul><li>63<br />3. Extended procedures<br /><ul><li>Gram stain and bacterial culture of unit
  75. 75. Quantitative serum Hemoglobin.
  76. 76. Serum Haptoglobin , pre and post transfusion
  77. 77. Peripheral blood film.
  78. 78. Coagulation and renal output study
  79. 79. Urine hemosiderin</li></li></ul><li>64<br />Sumber infeksi (Kontaminasi bakteri)<br />Infeksi dari darah simpan sangat jarang.<br />Kontaminan kulit tidak terlalu sering ada pada darah segar transfusi (organisme ini (terutama staphylococci tidak bertahan pada suhu simpan 4 º C namun dapat tumbuh cepat pada konsentrat trombosit yang disimpan pada 22 º C.<br />Darah donor yang mengalami bacteremia pada saat mendonorkan. Mayoritas adalah Yersinia enterocolitica, yang tumbuh sangat baik pada komponen sel darah merah karena ketergantungannya pada sitrat dan besi.<br />Gram negatif, endotoksin – produk/ kontaminan yang ditemukan pada tanah, tempat kotor, feses dapat tumbuh pada darah simpan.<br />
  80. 80. 65<br />Bacterial Detection Options in Platelet Products<br />Visual examination for discoloration, clumping or abnormal morphology<br />Microscopy<br />Gram stain <br />Acridine orange <br />Measuring Biochemical changes<br />Lowered pH<br />Reduced Glucose<br />Bacterial culture<br />Detection through oxygen consumption<br />Detection through CO2 production<br />
  81. 81. 66<br />Bacterial Detection Options in Platelet Products<br />Visual Examination<br />Inspect product prior to transfusion for discoloration or abnormal clumping<br />Perform “swirl” procedure to detect morphologic changes in platelets<br />Normal shaped platelets will align with fluid flow and “shimmer” when swirled<br />Contaminated platelets, among others, lose discoid shape and do not “shimmer” when swirled– Not a specific marker for contamination<br />
  82. 82. 67<br />Swirling<br />Alignment with flow<br />SENSITIVITY: 75%<br />SPECIFICITY: 95%<br />No alignment with flow<br />Low pH<br />Metabolic disturbance<br />Leach MF et al. Vox Sang 1998;74(suppl 1):1180.<br />
  83. 83. 68<br />Bacterial Detection Options in Platelet Products<br />Microscopic Methods<br />Gram Stain or Acridine Orange preferred methods<br />Limitations:<br />Must be performed by the Transfusion Service prior to product issue for transfusion<br />Lack sensitivity with low bacterial load<br />
  84. 84. 69<br />Bacterial Detection Options in Platelet Products<br /> Measuring Biochemical Changes<br />Measure changes in glucose consumption against a control. Variances of >2 S.D. may indicate bacterial contamination<br />“Dipstick” testing<br />Limitations:<br />Both this method and staining methods are subjective, require high levels of contamination, and must be performed prior to issue by the Transfusion Service<br />
  85. 85. 70<br />Detecting Bacteria in Platelets:<br />Biochemical Changes<br />Glucose, % Day 0<br />-2 SD<br />Storage Time, d<br />after Burstain JM et al. Transfusion 1997;37:255-8.<br />
  86. 86. 71<br />Chemical Tests - Dipsticks<br />Must be performed immediately before issue because of its<br />relative insensitivity and the need for high bacterial counts<br />
  87. 87. 72<br />Bacterial Detection Options in Platelet Products<br />Blood Culture Methods<br />Two methodologies presently approved by FDA for Quality Control use<br />bioMeriuex BacT/Alert System<br />Pall Biomedical BDS System<br />
  88. 88. 73<br />Bacterial Detection Options in Platelet Products<br />bioMeriuex BacT/Alert System<br />Detects bacterial growth in culture bottles by measuring CO2 production<br />Automated reader continuously monitors samples<br />Sampling interval of >24 hours post phlebotomy<br />Culturing interval of >24 hours post sampling (aerobic and anaerobic cultures)<br />Cultures incubate for 5-7 days; may identify positive cultures post-transfusion<br />FDA-Approved for Q.C. purposes only on Leukoreduced Apheresis Platelets<br />
  89. 89. 74<br />Bacterial Detection Options in Platelet Products<br />Pall Biomedical BDS System<br />Detects bacterial contamination by measuring O2 consumption<br />Automated reader measures O2 levels in headspace of culture pouch<br />Sampling interval of >24-48 hours<br />Culture performed for >24-30 hours<br />FDA-Approved for Q.C. on leukoreduced platelet concentrates and leukoreduced apheresis platelets<br />
  90. 90. 75<br />Detecting Bacteria in Platelets:<br />Detection of Growth by O2 Consumption<br />Pall BDS system<br />Measure %O2<br />in headspace<br />24 h<br />Limit: 19.5%<br />Filter: Stops<br />WBCs+Plts<br />Passes: Bacteria<br />24 h at 35C<br />Gas impermeable bag<br />
  91. 91. 76<br />Bacterial Contamination of PlateletsPrevention and Detection Options<br />Donor screening – not feasible except for arm screening. Can’t detect asymptomatic bacteremic donors<br />Arm Preparation-Limited effectiveness of arm scrub<br />Pathogen reduction – not yet available. May not inactivate spore forming organisms<br />Better phlebotomy methods and initial blood diversion<br />Bacterial detection offers best confirmatory option<br />
  92. 92. 77<br />Practical Application of Culturing <br />in a Transfusion Service Laboratory<br />Aubuchon, Dartmouth<br />Experience in first 3 years:<br /> 3,927 apheresis units cultured <br />(5 mL into aerobic bottle, BacT/Alert automated system)<br /> 23 initial positives (0.5%) in 28 h (10-69)<br /> 14 not confirmed on repeat culture<br /> 5 not able to be recultured <br /> 4 confirmed positives<br />RATE = 1/1,000 units (95% CI: to 1/600)<br />
  93. 93. 78<br />Bacterial Detection Options in Platelet Products<br />Limitations of Blood Culture Methods<br />Early sampling/testing may not detect small # bacteria per bag. Approved methods require 24-30 hour wait before sampling<br />Two FDA-Approved methods require bacteria to grow up after sampling to detectable levels, so culture must be done well before planned transfusion (Blood Center)<br />The two time intervals (collection to sampling and sampling to release/transfusion) dominate the logistic considerations<br />
  94. 94. 79<br />Bacterial Detection Options in Platelet Products<br />Limitations of Blood Culture Methods<br />Both options require leukoreduced platelets<br />BacT/Alert requires continued culture after product release<br />Release and recall (BacT/ALERT) or hold to end of culture to release (PALL BDS)<br />
  95. 95. 80<br />Bacterial Detection Options in Platelet Products<br />Limitations of Blood Culture Methods<br />Need to balance the risk of platelet shortages versus the risk of platelet contamination<br />The two available devices are FDA-Approved for Q.C, and not approved as pre-release tests <br />Cost<br />Probable negative impact on outdates<br />Possible extension of platelet storage to seven days or pooling/storing whole blood derived platelets<br />
  96. 96. 81<br />Bacterial Contamination in Transfusable Blood Products<br />AABB Guidance<br />Association Bulletin #03-07 issued May 16, 2003<br />Provides guidance for methods to limit contamination and to detect contamination<br />
  97. 97. 82<br />AABB Association Bulletin #03-07May 16, 2003<br /> Methods to Limit Contamination:<br />Careful phlebotomy – No green soap prep<br />Iodine based scrub recommended<br />Consider phlebotomy diversion – “sample first” technologies<br />Consider increased use of apheresis platelets<br />
  98. 98. 83<br />AABB Association Bulletin #03-07May 16, 2003<br /> Methods to Detect Contamination:<br />Culture methods optimal. Two approved products cited. Other culture methods can be validated. No label claims allowed<br />Due to insensitivity, staining and dipstick methods should be used as close in time to issue as possible<br />Validation of all methods is required<br />“Swirl” procedure useful for inspection but does not by itself meet AABB Standard 5.1.5.1<br />
  99. 99. 84<br />Contoh pemeriksaan identifikasi Ab dengan gelcard (serascan Diana)<br />
  100. 100. 85<br />Frekuensi Reaksi Transfusi akut<br />USA<br />Acute hemolytic, immune mediated (fatal) - 1 case per 250,000-600,000 population <br />Acute hemolytic, immune mediated (nonfatal) - 1 case per 6000-33,000 population <br />Acute hemolytic, nonimmune - Infrequent <br />Febrile, nonhemolytic - 1 case per 200 population <br />Allergic - 1 case per 333 population <br />Anaphylactic - 1 case per 20,000-50,000 population <br />TRALI - 1 case per 5000 population <br />Circulatory (volume) overload - Varies with concurrent illness <br />Bacterial contamination/endotoxemia -The incidence of septic reactions may be as high as 1 case per 700 pooled random donor platelet concentrates, 1 case per 4000 single-donor (pheresis) platelet products, and 1 case per 31,000 red cell transfusions.<br />
  101. 101. 86<br />Investigasi lab RTHA<br />Inspeksi visual plasma resipien <br /><ul><li>sampel vena dengan antikoagulan disentrifus plasma : merah muda- merah
  102. 102. Warna merah dpt timbul meski baru bbrp ml darah inkompatibel yg ditransfusikan</li></ul>Inspeksi visual urine resipien: merah<br />( Dalam bbrp menit stlh transfusi darah grup ABO yang inkompatibel)<br />
  103. 103. 87<br />Febrile transfusion reaction<br />•>1°C rise in temp and >38°C during <br />transfusion or within 4 hours<br />• Possibilities…<br />– Acute haemolytic transfusion reaction<br />– Febrile non-haemolytic transfusion reaction<br />– Bacterial contamination<br />– Fever unrelated to transfusion<br />
  104. 104. 88<br />Febrile transfusion reaction<br />Management<br />1. Stop transfusion <br />& maintain access with IV saline<br />2. Record vital signs<br />3. Recheck ID of patient and unit of blood<br />4. Advise medical officer<br />5. Report reaction to transfusion laboratory<br />
  105. 105. 89<br />Febrile transfusion reaction<br />• Transfusion reaction pack<br />• Investigations<br />– Return unit with clamped giving set<br />– Samples to recheck blood group and cross-match<br />– Urine to check for haemoglobinuria<br />– Take peripheral blood cultures (not from line)<br />– Complete transfusion reaction form<br />
  106. 106. 90<br />
  107. 107. 91<br />Reaksi transfusi kontaminasi bakteri<br />Onset cepat, tingkat mortalitas tinggiid onset and high mortality in recipients.<br />The presence of bacteria in transfused blood may lead either to febrile reactions in the recipient ( due to pyrogens ) or serious manifestations of septic or endotoxic shock.<br />Commonly caused by endotoxin produced by bacteria capable of growing in cold temperatures such as Pseudomonas species, E. coli, Yersinia enterocolitica.<br />
  108. 108. 92<br />Source of infection (bacterial contamination)<br />Infection of stored blood is extremely rare.<br />Skin contaminants are not infrequently present in freshly donated blood but these organisms ( predominantly staphylococci ) do not survive storage at 4 º C although they will grow profusely in platelet concentrates stored at 22 º C.<br />Healthy donor who are bacteremic at the time of donation. The majority are due to Yersinia enterocolitica, which grows well in red cell components due to its dependence on citrate and Iron.<br />Gram negative, endotoxin – producing contaminants found in dirt, soil and faeces may rarely grow in the storage condition of blood.<br />
  109. 109. 93<br /><ul><li>According to CDC , most are caused by blood components contaminated by Yersinia enterocolitica.
  110. 110. Since 1987, from 20 cases reported to CDC, 12 are caused by this organism.</li></li></ul><li>94<br />Clinical manifestation (bacterial contamination)<br />Usually appear rapidly during transfusion or within about 30 minutes after transfusion with dryness, flushing of skin.<br />Fever, Hypotension, Chills, Muscle pain, vomiting, Abdominal cramps, Bloody diarrhoea, Hemoglobinuria, Shock, Renal failure, DIC.<br />
  111. 111. 95<br />Management (bacterial contamination)<br />Rapid recognition is essential<br />Immediately stop the transfusion.<br />Therapy of shock, steroids, vassopressors, fluid support, respiratory ventilation and maintenance of renal function.<br />Broad spectrum IV antibiotics<br />The blood component unit and any associated fluids and transfusion equipment should be sent immediately to blood bank for investigation ie: gram stain and culture.<br />Blood C & S from the recepient.<br />
  112. 112. 96<br />Compatibility testing<br />• Agglutination <br />- IgM antibodies<br />- IgG anti A or anti B<br />• Indirect anti human globulin (Coombs) test<br />• Crossmatch<br />
  113. 113. 97<br />Why transfuse?<br />• Bleeding<br />• Hb less than normal<br />•Wound healing<br />• Rapid recuperation<br />• A tonic<br />
  114. 114. 98<br />Management of acute transfusion reaction<br />1. Stop transfusion<br />2. Keep IV open<br />3. Verify correct unit and patient<br />4. Notify laboratory<br />5. Send report of reaction, blood and urine <br />sample, blood unit, giving set to laboratory<br />
  115. 115. 99<br />
  116. 116. 100<br />
  117. 117. 101<br />
  118. 118. 102<br />Thank You !<br />www.themegallery.com<br />
  119. 119. 103<br />Interpretation<br />In an anesthetized patient the only symptoms of an HTR may be oozing, bleeding, or hypotension,, as experienced by this patient. The erroneously trans­fused group A donor unit RBCs reacted with the pa­tient's anti^A^antTbody, resulting in destruction of the transfused cionor cells. The coagulation system was activated, resulting in a hemorrhagic diathesis with resultant acute renal failure and death.<br />To prevent HTR, identity of the patient and donor blood component by two persons is essential to en­sure that the appropriate blood component is trans­fused. Blood must never be released if it is identified by a patient's name. There must be not only verifi­cation policies but also monitoring to ensure that established policies are adhered to. At the first sign of a transfusion reaction, the transfusion must be stopped, a line left open for normal saline adminis-<br />
  120. 120. 104<br />tration, the patient immediately attended to, and an immediate investigation initiated. Most errors in ABO mismatch of blood transfusion are misidenti-fication of either the patient or blood sample. Hu­man errors resulting in serious or fatal transfusion reactions are often litigated, not excused.<br />

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