TRANSFUSI
DARAH
BLOOD
TRANSFUSI DARAH YANG
AMAN
REAKSI REAKSI
TRANSFUSI DARAH
Bila dilaksanakan pemeriksaan
laboratorium pra- transfusi darah,
mayoritas transfusi darah tidak
memberikan efek samping ke pada
pasien
Komplikasi UMUM:
- reaksi reaksi transfusi
- penularan/transmisi penyakit infeksi
- sensitisasi imunologis
- hemokromatosis
REPORTING of SERIOUS HAZARDS of
TRANSFUSION (SHOT)
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
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
REAKSI REAKSI
TRANSFUSI DARAH
Bila dilaksanakan pemeriksaan laboratorium pra-
transfusi darah, mayoritas transfusi darah tidak
memberikan efek samping ke pada pasien
A,B, AB, O
Rhesus + / -
Golongan darah jarang
Sistem golongan darah eritrosit utama pada manusia
O OO H Anti-A 45 30
Anti-B
A1 A 1 A1 A + A1 Anti-B
A1 O
A 1 A2
41 38
A2 A 2 A2 A+H Anti-B
(Anti A1)
A2 O
B B + (H) Anti-A 11 22
BB
BO
A1B A + A1 + B tidak ada
A1 B 3 10
A2B A + B + (H) (Anti A1)
A2 B
PEMERIKSAAN SEROLOGI
GOLONGAN DARAH PRA
TRANSFUSI
PEMERIKSAAN GOLONGAN DARAH ABO dan Rhesus pada
PASIEN DAN DONOR
Pemeriksaan CROSSMATCHING (reaksi kecocokan silang)
Component/Product
Whole Blood RBCs (approx. Hct 40%); plasma; 500 ml Increase both cell mass & plasma
WBCs; platelets (WBCs & platelets not functional; plasma deficien
in labile clotting Factors V and VIII)
Red Blood CellsRBC (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 symptomatic
Adenine-Saline plasma, WBCs, and platelets; anemia (WBCs and platelets not
Added 100 ml of additive solution functional)
RBCs Leukocytes > 85% original volume of RBC; 225 mlIncreased red cell mass; < 5 x 106 WBCs
Reduced (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 transmission
RBCs Washed RBCs (approx, Hct 75%); 180 ml Increase red cell mass; reduced risk of
< 5 x 108 WBCs; no plasma allergic reactions to plasma proteins
RBCs Frozen; RBC (approx. Hct 75%); 180 ml Increased red cell mass; minimize
RBCs Deglycerolized < 5 x 10 WBCs; no platelets;
8
febrile or allergic transfusion reaction;
no plasma for prolonged RBS blood storage
(Continued)
Table 1. Blood Components and Plasma Derivatives (2)
Garnulocytes Granulocytes (>1.0 x 1010 220 ml Provide granulocytes for selected patients
Pheresis PMN/unit); lymphocytes; with sepsis and severe neutropenia
platelets (>2.0 x 1011/unit); (< 500 PMN/µL)
some RBCs
Platelets Pheresis Platelets (> 3 x 1011); 300 ml Same as platelets;l sometimes HLA
RBCs; WBCs; plasma matched
Platelets Leukocytes Platelets (as above);< 5 x 106 300 ml Same as platelets; < 5 x 106 WBCs to
Reduced WBCs per final dose of pooled decrease the likehood of febrile reactions,
platelets alloimmunization to leukocytes (HLA
antigens), or CMV transmission
FFP; FFP Donor Plasma; anticoagulation factors; 220 ml Treatment of some coagulation disorders
Retested plasma; complement (no platelets)
Solvent/detergent-
Treated plasma
Cryoprecipitated Fibrinogen; Factors VIII and XIII; 15 ml Deficiency of fibrinogen; Factor XIII;
AHF von Willebrand factor second choice in treatment of
hemophilia A, von Willebrand’s disease
(Continued)
Table 1. Blood Components and Plasma Derivatives
Factor 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 for
Recombinant 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 vary
Nant human in purity)
Factor IX)
Immune Globulin IgG antibodies preparations for varies Treatment of hypo-or agammaglobuline
IV and / or IM use mia; disease prophylaxis; autoimune
thrombocytopenia (IV only)
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
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
Indikasi Penggantian faktor – faktor Hemostatik pada Pasien Trauma
- Pedoman klinis :
* luas dan lokasi perlukaan
* lama renjatan berlangsung
* respon terhadap resusitasi awal
* risiko komplikasi, misalnya perdarahan intrakanial
(continued)
Table 5. Acute Transfusion Reactions (2)
Allergic (mild Urticaria (hives), rarely Antibodies to plasma Stop transfusion; Pre-transfusion
To 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 check
pre-
transfusion IgA
levels in patients
with a history of
of anaphylaxis
to transfusion
Hypervolemic 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)
Table 5. Acute Transfusion Reactions (3)
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 :
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
TERIMA KASIH