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Reaksi transfusi

Pengertian
Gejala dan tanda
abnormal yang timbul
pada saat dan beberapa
hari sesudah transfusi

Gejala dan tanda:


1. Cepat (acute)
2. Lambat (delayed)

Derajat Reaksi Transfusi:

Ringan
Suhu meningkat
Sakit kepala
Alergi
Dll
Berat
Reaksi
hemolisis
Meninggal

Faktor penyebab

1. Faktor darah
2. Faktor
transfusi

1. Faktor darah

lasifikasi Reaksi transfus


I. Reaksi hemolitik
II. Reaksi nonhemolitik
III. Penularan
penyakit

II.Reaksi non-hemolitik

III.Penularan penyakit

2. Faktor Transfusi
1. Overtransfusion
2. Suhu darah kurang sesuai
3. Emboli udara
4. Mikroemboli
5. Intoksikasi sitrat
6. Hemosiderosis
7. Tromboflebitis

3. Faktor Resipien
1.Multipara atau
Multitransfusi (PTP,
DHTR)
2.Defisiensi IgA
(anafilaksis)
3.Reaksi alergik
4.AIHA

Komplikasi
Transfusi

Komplikasi
Transfusi

Reaksi Hemolitik

Faktor darah
Reaksi

Inkompatibilitas ABO
Donor gol A (

Inkompatibilitas ABO
Donor gol

Inkompatibilitas

Bila

eaksi hemolitik akut


Timbul segera (pd 15 mnt pertama,
namun dpt terjadi kapan saja ) pd saat
transfusi berlangsung
Dgn 50 mL darah yg tdk cocok sdh dpt
menimbulkan reaksi
Krn inkompatibilitas ABO
Tanda
Gejala
Terjadidan
akibat
clerical error (human
error)
Rasa panas
sepanjang vena
Demam dan
menggigil
Nyeri pinggang
yang khas
Rasa tertekan pada
dada

Reaksi hemolitik akut (RHA),


sambungan
Gejala dan tanda:
Hipotensi (bila terjadi prognosis jelek)
Sakit kepala
Muka menjadi merah
Ikterus
Urine warna merah (hemoglobinuria)
Tidak sadar: nadi kecil tdk teraba, nafas
cepat
Tahap lanjut: GGA, DIC

Insidensi bervariasi :
RHA imun fatal, 1: 250.000 600.000

eaksi hemolitik lambat


Terjadi bbrp jam atau bbrp hari
(10 14 hari) sesudah transfusi
Biasanya pada labu ke 2 atau
lebih
Pd penderita yg sering
mendapat transfusi / pernah
melahirkan
Dpt terjadi pd pemberian gol O
titer anti-A dan anti-B tinggi kpd
gol darah lain.
Gejala:

bel. Klasifikasi Reaksi Transfusi


Reaksi transfusi akut
Imunologik

Non
imunologik

Reaksi transfusi
lambat
Imunologik

Non
imunologik

Reaksi hemolitik
akut

Konta minasi
bakteri (septik)

Reaksi
hemolisis
lambat

Kelebihan besi

Reaksi demam
non hemolitik

Kelebihan cairan
(hipervolemik)

Alloimunisasi

Penularan
penyakit

Reaksi alergi
(Mis. urtikaria)

Hemolisis non
imun

Reaksi transfusi
graft versus
host

Anafilaksis

Transfusi masif

Purpura paska
transfusi

Transfusion
related acute
lung injury
(TRALI)

Komplikasi
metabolik:
hipotermi,
koagulopati

Transfusion
related
immunomodulat
ion

EL. ETIOLOGI REAKSI TRANSFUSI HEMOLITIK AKUT DAN LAMBAT

Klasifikasi
Reaksi
Segera (Akut)

Penyebab

Efek

a. Imunologik

Inkompatibilitas
RBC
Ab thdp lekosit
donor
Ab (IgM) thdp IgA
Ab thdp lekosit
resipien
Ab thdp protein
plasma

Hemolisis dgn
gejala
Panas non-hemolitik
Anafilaksis
Edema paru non
kardial
Urtikaria

b. Nonimunologik

Darah
terkontaminasi
Hipervolume
(Kelebihan volume)
Darah rusak sblm

Panas tinggi, syok


Payah jantung
kongestif
Hemolisis tanpa
gejala

EL. ETIOLOGI REAKSI TRANSFUSI HEMOLITIK AKUT DAN LAMBAT

Klasifikasi
Reaksi
Lambat
a. Imunologik

b. Nonimunologik

Penyebab

Efek

Anamnestic Ab
thdp Ag RBC
Ab thdp limfosit
Ab thdp trombosit

Hemolisis

Sering transfusi

Hemosiderosis,
hemoragi metabolik
Hepatitis, malaria,
sifilis
Tromboflebitis

Penularan penyakit
Emboli
Infeksi pd tempat
tusukan jarum

Reaksi graft versus


host
Purpura post
transfusi

Tabel. Reaksi transfusi akut


Type

Intravasc
ular
hemolytic
(immune)
(acute
hemolytic
)

Sign and
Symptoms

Usual Cause

Treatment

Prevention

Hemoglobine
mia and
Hemoglobin
uria, fever,
chills,
anxiety,
shock, DIC,
dyspnea,
chest pain,
flank pain,
oliguria, LBP,
flushing,
bleeding
tachycardia,
hypote nsion,
Cardiovascu

ABO
incompati
bility
(clerical
error),
complemen
t
fixing,antib
ody
causing,
antigen
antibody
incompatibi
lity

Stop
transfusion;
Other
hydrate,
support,
blood
pressure &
respiration;
induce
diuresis;
treat shock,
and DIC, if
present

Avoid
clerical
Errors ;
ensure
proper
sample &
recipient
identificatio
n

Tabel. Reaksi transfusi akut


Type

Sign and
Symptoms

Usual Cause

Treatment

Prevention

Extravascu
lar
Hemolytic
(immune)

Fever, malaise,
hiperbilirubine
mia, increased
urine urobilinogen, falling
hematocrit

Indirect IgG,
noncomplementfixing
antibody
often
associated
with delayed
hemolysis

Monitor Ht,
renal &
hepatic
function,
coagulation
profile, no
acute
treatment
generally
required

Avoid
clerical
Errors ;
ensure
proper
sample &
recipient
identification

Febrile
hypotensio
n

Chills (panas
dingin) and
fever,
headache,
flushing,
anxiety,
muscle pain,
chest
tightness,

Antibodies to
leukocytes or
plasma
protein;
hemolysis;
passive cyto
kines;
infusion;
sepsis.
Commonly

Stop
transfusion;
give
antipyretic;
eg,
acetaminoph
en for rigors
use
meperidine
25-50 mg IV

Pre
transfusion
antipyretic;
leukocytereduced
blood if
recurrent

Tabel. Reaksi transfusi akut


Type

Sign and
Symptoms

Usual Cause

Treatment

Prevention

Allergic
(mild to
severe)

Urticaria (hives),
rarely hypotension
or anaphylaxis
(Broncho spasm,
wheezing,
dyspnea,
tacypnea),
Cyanosis Cardiovas
cular- tachycardia,
hypotension,
shock, cardiac
arrest, GI, N and V,
cramping diarrhea
Onset- Immediate

Antibodies to
plasma
proteins;
rarely,
antibodies to
IgA (developed
IgA antibodies
from
pregnancy or
previous
transfusion)

Stop
transfusion;
give
antihistamine
(PO or IM); if
severe:
epinephrine
and /or
steroids

Hipervole
mic

Dyspnea,
hypertension,
pulmonary edema,
cardiac arrhytmias

Too rapid
and/or
excessive
blood
transfusion

Induced
Avoid rapid or
diuresis;
excessive
phlebotomy;
transfusion
support cardiorespiratory
system as
needed

Pre-transfusion
antihistamine;
washed RBC
components; if
recurrent or
severe check
pre-transfusion
IgA levels in
patients with a
history og
anaphylaxis to
transfusion

ble. Reaksi transfusi akut


Type

Sign and
Symptoms

Usual Cause

Treatment

HLA or
leukocyte
antibodies;
usually donor
antibody
transfused
with plasma in
components

Support blood
pressure and
respiration
(may require
intubation)

Transfusion
related acute
lung injuri
(TRALI)

Dyspnea,
fever,
pulmonary
edema,
hypotension,
normal
pulmonary
capillary
wedge
pressure

Bacterial
sepsis

Rigor, chills, Contaminate


fever, shock, d blood
vomiting and component
diarrhea

Prevention
Leukocytereduced RBCs
if recipient has
the antibody;
notify
transfusion
service to
quarantine
remaining
components
from donor

Stop transfusion; Care in blood


support blood
collection and
pressure; culture storage;
patient and
careful
blood unit; give
attention to
antibiotics;
arm
notify blood
preparation
transfusion
coagulation;
IV = intravenous;
IM = for
service
phlebotomy

DIC = disseminated intravascular


intramuscular; PO = per oral (by mouth); RBC = red blood cells

Common transfusion reactions and transfusion process problems:


presentation and managementReaction/eventFebrile non-haemolytic
reactionsMinor allergic reactions Transfusion associated circulatory
overload (TACO) Incorrect blood component transfused, or wrong
dose or rate of transfusionKnown or postulated mechanism(s)HLA
antibodies or reaction to inflammatory cytokines in transfused
components (or both)Reaction to plasma proteinsRarely, reaction to
drug or foodstu ingested by blood donorCirculatory (volume)
overloadProduct intended for another patient or did not meet the
patients special requirements (for example, required irradiated
components)Wrong product, dose, or rate prescribed or
administeredManagement and preventionUsually short lived and not
serious (although unpleasant for the patient)Symptomatic
management with antipyretics/analgesics if prolonged or severe
rigorsIn process or prestorage leucocyte reduction of blood
components (bedside leucocyte reduction of limited bene.t)Minor
reactions usually short livedSymptomatic management with
antihistamines if neededIf recurrent and troublesome, pretreatment
with antihistamine/steroid may be indicatedInfants, older patients,
and those with comorbidities (such as cardiac and renal impairment)
are particularly vulnerable to TACOCheck pre-transfusion volume
status and monitor fluid balance carefullyTransfuse only one unit at a
time and review a.er each unitDiuresis between units if transfusing
multiple units, but TACO may occur a.er only a single unit
transfusedThese are usually due to: Procedural errors (such as
failure to properly identify the intended recipient) Poor
communication between members of clinical teams or between

mpat terjadinya hemolis


1. Intravaskuler
2. Ekstravaskuler

Hemolisis intravaskuler
Imunologik
Anti-A, anti-B, Anti-AB (jenis
IgM)Inkompatibilitas ABO & Rh
Segera
Tanda dan gejala
o Cemas, muntah, diare
o Demam, menggigil, nyeri dada dan
pinggang
o Circulatory collapse
o Hemoglobinemia, hemoglobinuria,
ikterus
o Perdarahan tdk terkontrol fatal
o Gagal ginjal
Angka kematian 10%
Non-Imunologik

Hemolisis ekstravaskule
Selama transfusi
Umumnya krn anti-D (jenis IgG)
Reaksi tdk sehebat intravaskuler
Gejala dan tanda
Demam, menggigil
Kadar Hb turun, sp 10 hari pasca
transfusi
Reaksi jarang fatal
Tdk diikuti gagal ginjal
Hemolisis tertunda (lambat)
7 hari kemudian
Demam, ikterus
Insidensi 1:4000

Tanda dan gejala pd reaksi


transfusi
GK

aksi transfusi yg berbah

jadi krn:

appropriate specification, 33%


lah darah, 20%
ansfusi tdk sesuai (inappropriate transfusion),
salahan pengujian pre-transfusi, 12%
ndling error, 7%

Frekuensi Reaksi Transfusi

emam non-hemolitik (Febris), 1: 200


ontaminasi bakteri 1:700
RALI (Transfusion related acute lung injury 1:5
ergi, 1:33.000
nafilaksis, 1:20.000 50.000
emolitik akut, 1:250.000 600.000
ansfusion associated graft-versus-host disea
rong blood is given to patients
elayed haemolysis

Table 4 | Some complications of transfusion and their


approximate frequency. Data taken from the Serious Hazards
of Transfusion scheme17
Transfusion risk
Frequency in the UK (units
ABO incompatible red cell transfusion
1/180 000
transfused)
Incorrect blood component transfused (excluding ABO incompatible
red cell transfusions)
1/13 000
Serious acute transfusion reaction
1/7000
Transfusion related acute lung injury
1/150 000
Transfusion associated circulatory overload 1/450 000
Transfusion associated graft versus host disease
Rare since
implementation of
universal leucocyte reduction of
blood components in the UK in
1999
Post-transfusion purpura
Rare since implementation of
universal leucocyte reduction of
blood components in the UK in
1999
Transfusion transmitted infection:
HIV
1/6.25 million
Hepatitis B virus
1/1 million
Hepatitis C virus
1/100 million

MJ | 20 JULY 2013 | VOLUME 347

Transfusion reaction acute lung injury (TRALI)

Table 4. Workup of an Acute Transfusion


Reaction
If
an acute transfusion reaction occurs :
1. Stop blood component transfusion immediately
2. Verify the correct unit was given to the correct patient
3. Maintain IV access and ensure adequate urine output
with an appropriate crystalloid or colloid solution
4. Maintain blood pressure, pulse
5. Maintain adequate ventilation
6. Notify attending physician and blood bank
7. Obtain blood / urine for transfusion reaction workup
8. Send blood bag and administration set to blood
transfusion service immediately
9. 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)

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

Table 4. Workup of an Acute Transfusion


Reaction
If intravascular hemolytic reaction is confirmed
10. Monitor renal status (BUN, creatinine)
11. Initiate a diuresis
12. Analyze urine for hemoglobinuria
13. 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
Adapted from snyder EL. Transfusion reaction. In : Hoffman R, Benz. EF Jr, Shattil
patients, and treat as appropiate
SJ, et al. Hematology : Basic Principle and practice, 2 ed. Ney York : Chruchill
nd

Tindakan

Reaksi Non-Hemolitik

Reaksi Non-Hemolitik
Alergi
Pirogen
Kontaminasi bakteri
Overloading
Gangguan irama jantung
Keracunan citrat
Keracunan kalium
Gangguan pembekuan
Emboli

Anafilaksis

Kontaminasi bakteri

Kontaminasi bakteri

Kontaminasi bakteri

Kontaminasi bakteri

Overloading

Gangguan irama jantung

Keracunan citrat

Keracunan Kalium

Gangguan pembekuan

Emboli

Penularan Penyakit

Malaria

Pemeriksaan
pd
Reaksi transfusi

ra periksa:
alahan administrasi
iksa sisa darah apakah ada hemolisis: warna merah
iksa DAT (direk antiglobulin tes)
Bila reaksi transfusi hemolitik
Periksa:
1.Kesalahan administrasi
2.Kesalahan golongan darah
3.Uji silang golongan darah (crossmatch)
4.Hemoglobinemia menyebabkan
hemoglobinuria
5.DAT, positif
Bila reaksi Non-hemolitik (immune-mediated)
1.Pasien akan menggigil, demam, sesak napas,
edema paru
2.Reaksi alergi berat anafilaksis (anti IgA)
3.Purpura krn antiplatelet

Bila hemolisis (lanjutan), periksa:


1.Bilirubin serum 5-7 pasca transfusi
2.Serum Haptoglobulin,
methemalbumin, LDH
3.Hemosiderin urine
4.Hitung jlh retikulosit
5.Fragilitas osmotik
6.Apus darah, utk melihat sferositosis
Bila hemolisis non-imunologik,
periksa:
1.Kesalahan penyimpanan
2.Kesalahan pemeriksaan
3.Kesalahan cairan infus
4.Sickle cells

Bila tdk ada kesalahan ABO, crossmatch,


maka periksa:
1.Antibodi penderita
2.Antibodi donor
3.Penyebab hemolisis lain
Bila hasil pemeriksaan negatif, lakukan:
4.Pemeriksaan fenotipe dan genotipe
penderita dan donor
5.Periksa antibodi pd serum donor dan
penderita
6.Kirim sampel ke UTD pusat

Pemeriksaan Lab RHA


I.

II.
III.

IV.

V.

Pem hemoglobinemia
1. Visual, sampel pre dan pasca tranfusi
a. Plasma yg kemerah-merahan (Hb 20 mg/dL)
b. Plasma jelas merah (Hb 30 mg/dL)
2. Laboratorik, bila visual negatif
a. Hb plasma
b. Serum haptoglobin
c. Serum methemoglobin
Pem antibodi
1. Antiglobulin test direk dan indirek
2. Identifikasi Ab dgn panel cells
Pem bil terutama indirek
1. Visual: sampel pre dan pasca transfusi
a. Kuning muda: normal
b. Kuning tua, akan jelas stlh 5 jam
2. Laboratorik: bil kuantitatif
Pem urine
1. Hemoglobinuria: sampel pasca transfusi
a. Visual: jambon, merah, coklat
b. Laboratorik: mikroskopik bila meragukan
2. Hemosiderinuria
Pem lain
Kadar Hb, trombosit, aPTT, PPT

Bila RHA
Bila diduga RHA cari penyebabnya
dgn:
Inspeksi visual
o Warna plasma resipien: merah
o Warna urine resipien: merah
Uji ulang pem gol ABO dan Rh: donor
dan resipien
o Hrs cocok (tdk ada perbedaan)
Uji AHG direk
o Bila krn inkompatibilitas ABO tes
AHG direk pos

mam/Febris non-hemoli
Bila terjadi demam, cek
penyebabnya
Inspeksi visual
Warna plasma resipien:
normal
Warna urine resipien:
normal
Uji ulang tes ABO dan Rh
Hrs cocok (tdk ada
perbedaan)

Reaksi anafilaksis
Plasma atau urine merah
Bila Inkompatibilitas ABO pre
dan paska; AHG direk pos
bukan reaksi anafilaksis
Pemeriksaan anti IgA
Serum/plasma resipien pre
transfusi (+) berarti reaksi
anafilaksis
Pemeriksaan IgA sampel resipien
pre transfusi menyingkirkan
diagnosis

Bila diduga kontaminasi


bakteri:
1.Inspeksi visual: perubahan
warna, gumpalan darah/PLY
2.Biakan darah dari contoh darah
diagnosis
3.Pemeriksaan utk
menyingkirkan reaksi hemolitik
(krn gejala mirip)

TRALI
Bila terjadi dugaan TRALI, maka
dilakukan:
1.Pemeriksaan BNP edema
paru TRALI atau edema paru
pada reaksi transfusi krn
kelebihan cairan
2.Menyingkirkan kemungkinan
sepsis krn mempunyai gejala
yang mirip
3.Menyingkirkan gejala yang
mirip krn mempunyai gejala

ngiriman sampel darah ke UTD pusat


Tujuan:
Utk penelusuran antigen eritrosit dan
serum antibodi penderita

anya:
mL darah penderita tanpa antikoagulan
ml darah penderita dgn antikoagulan citras 0.7
irim melalui UTDC dilengkapi dgn:
dentitas penderita
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