Table 1.

Blood Components and Plasma Derivatives (1)

Component/Product

Composition

Volume

Indications

Whole 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

plasma, WBCs, and platelets

250 ml Increase red cell mass in symptom

atic anemia (WBCs & platelets not
functional)

Red Blood Cells,

Adenine-Saline
Added

RBC (approx. Hct 60%); reduced

plasma, WBCs, and platelets;
100 ml of additive solution

330 ml Increase red cell mass in symptomatic

anemia (WBCs and platelets not
functional)

RBCs Leukocytes
Reduced (prepared by filtration)

> 85% original volume of RBC;

< 5 x 106 WBC; few platelets;
minimal plasma

225 ml Increased red cell mass; < 5 x 106 WBCs

to decrease the likelihood of febrile reactions, immunization to leukocytes (HLA)
antigens) of CMV transmission

RBCs Washed

RBCs (approx, Hct 75%);

< 5 x 108 WBCs; no plasma

180 ml

RBCs Frozen;
RBC (approx. Hct 75%);
RBCs Deglycerolized < 5 x 108 WBCs; no platelets;
no plasma

180 ml

Increase red cell mass; reduced risk of

allergic reactions to plasma proteins
Increased red cell mass; minimize
febrile or allergic transfusion reaction;
use for prolonged RBS blood storage
(Continued)

Table 1. Blood Components and Plasma Derivatives (2)

Component/Product Composition

Volume

Indications

Garnulocytes
Pheresis

Granulocytes (>1.0 x 1010

PMN/unit); lymphocytes;
platelets (>2.0 x 1011/unit);
some RBCs

220 ml

Provide granulocytes for selected patients

with sepsis and severe neutropenia
(< 500 PMN/L)

Platelets

Platelets (> 5.5 x 1010/unit);

RBC; WBCs; plasma

300 ml

Bleeding due to thrombocytopenia or

thrombocytopathy

Platelets Pheresis

Platelets (> 3 x 1011);

RBCs; WBCs; plasma

300 ml

Same as platelets;l sometimes HLA

matched

Platelets Leukocytes Platelets (as above);< 5 x 106 300 ml

Reduced
WBCs per final dose of pooled
platelets

Same as platelets; < 5 x 106 WBCs to

decrease the likehood of febrile reactions
alloimmunization to leukocytes (HLA
antigens), or CMV transmission

FFP; FFP Donor

Retested plasma;
Solvent/detergentTreated plasma

Plasma; anticoagulation factors;

complement (no platelets)

220 ml

Cryoprecipitated
AHF

Fibrinogen; Factors VIII and XIII;15 ml

von Willebrand factor

Deficiency of fibrinogen; Factor XIII;

second choice in treatment of
hemophilia A, von Willebrands disease

Treatment of some coagulatio

(Continued)

Table 1. Blood Components and Plasma Derivatives

Component/Product Composition

Volume

Indications

Factor VIII
Factor VIII; trace amount of other
(consentraes;
plasma proteins (products vary
Recombinant human
in purity)
Factor VIII)

25 ml

Hemophilia A (Factor VIII deficiency);

Willebrands disease (off-label use for
selected products only)

Factor IX (concenTrates, recombi

Nant human
Factor IX)

Factor IX; trace amount of other

plasma proteins (products vary
in purity)

25 ml

Hemophilia B (Factor IX deficiency)

Albumin/PPF

Albumin, some -, -globulins

(5%);
(25%)

Volume expansion

Immune Globulin

IgG antibodies preparations for

IV and / or IM use

varies Treatment of hypo-or agammaglobulinemia; disease prophylaxis; autoimune

thrombocytopenia (IV only)

Rh Immune
Globulin

IgG anti-D; preparations for IV

and/or IM use

Antithrombin

Antithrombin; trace amount of

other plasma proteins

1 ml

10 ml

Prevention of hemolytic disease of the

newborn due to D antigen; treatment of
autoimmune thrombocytopenia
Treatment of antithrombin deficiency

RBCs = 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

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

TRANSFUSI TROMBOSIT
Trombosit disimpan dalam Reciprocal agitator, pada
suhu (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)

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)

Corrected platelet increment (CI) =

(P1 P0) x BSA x n-1
P1 = platelet count before transfusion (109/l)
P0 = platelet count 1 hour after transfusion (109/l)
BSA = recipients body surface area, m2
N = number of units of platelet concentrates transfused,
each > 0,55 x 1011
A corrected platelet increment 1 hour after administration that is
Higher than 7,5 x 109/l indicates a successful transfusion of platelets

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 - 37 C)
harus segera ditransfusikan

Content of Cryoprecipitate
80 to 120 units of Factor VIII : C (procoagulant activity)
250 mg fibrinogen
20% to 30% of the factor XIII in the original unit
40% to 70% of the factor VIII : VWF (von Willebrand factor) in the
Original unit

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

REAKSI REAKSI
TRANSFUSI DARAH
Bila dilaksanakan pemeriksaan laboratorium pratransfusi 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

REPORTING of SERIOUS HAZARDS of

TRANSFUSION (SHOT)
Suspected or confirmed transfusion transmitted
infection (bacterial, viral, etc)
Clerical error (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

REAKSI REAKSI
TRANSFUSI DARAH
Yang paling sering timbul:
- reaksi febris
- reaksi alergi
- reaksi hemolitik

REAKSI FEBRIS
Nyeri kepala menggigil, suhu
meningkat
Umumnya reaksi ringan

REAKSI ALERGI
Reaksi alergi berat (anafilaksis): jarang
terjadi
Timbul urtikaria kulit, bronkospasme,
edema larings

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

REAKSI HEMOLITIK
REAKSI INTRAVASKULAR:
- hemolisis dalam sirkulasi darah
- jaundice dan hemogolobinemia
- paling bahaya anti-A dan anti-B spesifik
dari sistem ABO
- fatal akibat perdarahan tidak terkontrol
dan gagal ginjal

REAKSI HEMOLITIK
REAKSI EKSTRAVASKULAR:
- jarang sehebat reaksi intravaskular
- reaksi fatal jarang terjadi
- disebabkan antibodi IgG destruksi
eritrosit via makrofag
- menimbulkan penurunan tiba tiba kadar
Hb s/d 10 hari pasca transfusi

Table 5. Acute Transfusion Reactions (1)

Type

Sign and Symptoms

Usual Cause

Treatment

Prevention

Intravascular Hemoglobinemia and

hemolytic
hemoglobinuria, fever,
(immune)
chills, anxiety, shock, DIC,
dyspnea, chest pain,
flank pain, oliguria
identification

ABO incompatibility
(clerical error) or other
complement fixing
antibody causing
antigen antibody
incompatibility

Stop transfusion;
Avoid clerical
hydrate, support
errors; ensure
blood pressure &
proper sample
respiration; induce & recipient
diuresis; treat shock
and DIC, if present

Extravascular
Hemolytic
(immune)

Fever, malaise, indirect

hiperbilirubinemia,
increased urine urobilinogen, falling hematocrit

IgG
non-complementfixing antibody often
assoclated with
delayed hemolysis

Monitor Ht,
Avoid clerical
renal & hepatic
error : ensure
function, coagulati proper sample
on profile, no acute & recipient
treatment generally identification
required

Febrile

Fever, chill, rarely

hypotension

Antibodies to
leukocytes or plasma
protein; hemolysis;
passive cytokines
infusion; sepsis.
Commonly due to
patients underlying
condition

Stop transfusion;
give antipyretic;
eg, acetaminophen
; for rigors
Use meperidine 2550 mg IV or IM

Pre transfusion
antipyretic;
leukocytereduced blood
if recurrent

(continued)

Table 5. Acute Transfusion Reactions (2)

Type

Sign and Symptoms

Allergic (mild Urticaria (hives), rarely

To severe)
hypotension or anaphylaxis

Usual Cause

Treatment

Antibodies to plasma Stop transfusion;

proteins; rarely anti- give; antihistamine
bodies to IgA
(PO or IM); if severe,
epinephrine and/or
steroids

Prevention
Pre-transfusion
antihitamine;
washed RBC
components, if
recurrent or
severe check

pretransfusion IgA
levels in patients
with a history of
of anaphylaxis
to transfusion
Hypervolemic

Dyspnea, hypertension
pulmonary edema,
cardiac arrhytmias

Too rapid and/or

excessive blood
transfusion

Induced diuresis;
phlebotomy;
support cardiorespiratory system
as needed

Avoid rapid or
excessive
transfusion

(continued)

Table 5. Acute Transfusion Reactions (3)

Type

Sign and Symptoms

Usual Cause

Treatment

Transfusionreduced
related acute
lung injuri
(TRALI)

Dyspnea, fever

HLA or leukocyte

Support blood

Bacterial
sepsis

pulmonary edema,
hypotension, normal
pulmonary capillary
wedge pressure

Rigors, chills, fever,

shock

antibodies; usually pressure and

donor antibody
respiration (may
transfused with
require intubation)
plasma in compo
nents

Contaminated
blood component

Stop transfusion;
support blood
pressure; culture
patient and blood
unit; give antibiotics
; notify blood transfusion service

Prevention
LeukocyteRBCs if recipient
has the antibody;
notify transfusion
service to quarantine remaining
components from
donor
Care in blood
collection and
storage; careful
attention to armpreparation for
phlebotomy

DIC = disseminated intravascular coagulation; IV = intravenous; IM = intramuscular; PO = by mouth;RBC = red blood cells

Table 4. Workup of an Acute Transfusion Reaction

If an acute transfusion reaction occurs :
1.
2.
3.
4.
5.
6.
7.
8.
9.

Stop blood component transfusion immediately

Verify the correct unit was given to the correct patient
Maintain IV access and ensure adequate urine output with an appropriate crystalloid or colloid solution
Maintain blood pressure, pulse
Maintain adequate ventilation
Notify attending physician and blood bank
Obtain blood / urine for transfusion reaction workup
Send blood bag and administration set to blood transfusion service immediately
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 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 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