You are on page 1of 29

REAKSI – REAKSI TRANSFUSI DARAH

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

masalah ditempat tusukan .reaksi reaksi transfusi .KOMPLIKASI TRANSFUSI DARAH • Komplikasi LOKAL: .kegagalan memperoleh akses vena .vena pecah saat ditusuk.fiksasi vena tidak baik .penularan/transmisi penyakit infeksi .sensitisasi imunologis . dll • Komplikasi UMUM: .kemokromatosis .

alergi. sepsis bakteria.REAKSI TRANSFUSI DARAH • Reaksi Tranfusi Darah AKUT: hemolitik. panas. hipervolume. lung injury. dll • Reaksi Transfusi Darah LAMBAT .

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

• Reaksi jarang berat.REAKSI FEBRIS • Nyeri kepala  menggigil dan gemetar tiba tiba  suhu meningkat. • Berespon terhadap pengobatan .

bronkospasme moderat.REAKSI ALERGI • Reaksi alergi berat (anafilaksis): jarang • Urtikaria kulit. edema larings: respon cepat terhadap pengobatan .

REAKSI HEMOLITIK • REAKSI YANG PALING BERAT • Diawali oleh reaksi: .ekstravaskular .antibodi dalam serum pasien >< antigen corresponding pada eritrosit donor .antibodi dalam plasma donor >< antigen corresponding pada eritrosit pasien • Reaksi hemolitik: .intravaskular .

REAKSI HEMOLITIK • REAKSI INTRAVASKULAR (INVIVO): .hemolisis dalam sirkulasi darah .antibodi IgM .jaundice dan hemogolobinemia .fatal  akibat perdarahan tidak terkontrol dan gagal ginjal .paling bahaya anti-A dan anti-B spesifik dari sistem ABO .

reaksi fatal jarang .disebabkan antibodi IgG  destruksi eritrosit via makrofag .REAKSI HEMOLITIK • REAKSI EKSTRAVASKULAR (INVITRO): .menimbulkan penurunan tiba triba kadar Hb s/d 10 hari pasca transfusi .jarang sehebat reaksi intravaskular .

B. O • Rhesus POSITIF / NEGATIF • Golongan darah jarang .GOLONGAN DARAH • A. AB.

Lub K.S.e Lua.s P1.B M.Kpa.Jkb Dia.Ytb Xga Doa.k.C.c.Jsb Lea.E.Jsa.p D.Kpc.Cob Sc1.Kpb.Dib Yta.Sc2 Antibodi timbul secara alamiah Selalu Tak Kadang – kadang Tak Tak Tak Kadang – kadang Tak Tak Tak Tak Tak Tak Tak Tak ABO MNSs P Rh Lutheran (Lu) Kell Lewis (Le) Duffy (Fy) Kidd (Jk) Diego (Di) Cartwright (Yt) Xg Dombrock (Do) Colton (Co) Scianna (Sc) .Leb Fya.Fyb Jka.Dob Coa.Sistem golongan darah eritrosit utama pada manusia Tahun ditemukan 1901 1926 1926 1940 1945 1946 1946 1950 1951 1955 1956 1962 1965 1967 1974 Sistem Antigen utama pada eritrosit H.A.N.

Golongan darah ABO Fenotip Genotip Antigen eritrosit H Antibodi serum Anti-A Anti-B Anti-B Frekuensi Kaukasia Oriental 45 30 O OO A1 A1A1 A1O A1A2 A2A2 A2O BB BO A1B A2B A + A1 41 A2 B A+H Anti-B (Anti A1) Anti-A 11 38 B + (H) 22 A1B A2B A + A1 + B A + B + (H) tidak ada 3 (Anti A1) 10 .

AB dalam serum/plasma • PEMERIKSAAN GOLONGAN DARAH RHESUS: .Serum grouping (back typing): ada/tidaknya antibodi A. B.hanya antigen-D atau Du yang diperiksa pada eritrosit . dari 2 arah: .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.Cell grouping: ada/tidaknya antigen A atau B pada permukaan eritrosit .

Blood Components and Plasma Derivatives (1) Component/Product Whole Blood Composition Volume Indications RBCs (approx. RBC (approx. no plasma RBCs Frozen. and platelets 250 ml Increase red cell mass in symptom atic anemia (WBCs & platelets not functional) 330 ml Increase red cell mass in symptomatic anemia (WBCs and platelets not functional) Red Blood Cells Red Blood Cells. < 5 x 106 WBCs to decrease the likelihood of febrile reactions.Table 1. reduced risk of allergic reactions to plasma proteins RBCs Washed RBCs (approx. Hct 75%). and platelets. 500 ml Increase both cell mass & plasma WBCs. RBCs Deglycerolized < 5 x 108 WBCs. Adenine-Saline Added RBCs Leukocytes Reduced (prepared by filtration) RBC (approx. plasma. < 5 x 106 WBC. WBCs. no plasma 180 ml Increased red cell mass. use for prolonged RBS blood storage (Continued) . immunization to leukocytes (HLA) antigens) of CMV transmission 180 ml Increase red cell mass. reduced plasma. few platelets. minimize febrile or allergic transfusion reaction. Hct 60%). no platelets. reduced plasma. < 5 x 108 WBCs. Hct 75%). minimal plasma 225 ml Increased red cell mass. WBCs. platelets volume (WBCs & platelets not functional. Hct 40%). plasma deficient in labile clotting Factors V and VIII) RBC (approx. 100 ml of additive solution > 85% original volume of RBC. Hct 75%).

lymphocytes. 15 ml von Willebrand factor Deficiency of fibrinogen. < 5 x 106 WBCs to decrease the likehood of febrile reactions alloimmunization to leukocytes (HLA antigens).< 5 x 106 300 ml Reduced WBCs per final dose of pooled platelets Same as platelets. von Willebrand’s disease (Continued) . RBC. Factor XIII.Table 1. anticoagulation factors. Blood Components and Plasma Derivatives (2) Component/Product Composition Garnulocytes Pheresis Granulocytes (>1. Solvent/detergentTreated plasma Plasma. some RBCs Platelets (> 5. WBCs.220 ml complement (no platelets) Treatment of some coagulation disorders Cryoprecipitated AHF Fibrinogen. platelets (>2. or CMV transmission FFP. FFP Donor Retested plasma. plasma Volume 220 ml Indications Provide granulocytes for selected patients with sepsis and severe neutropenia (< 500 PMN/µL) Platelets 300 ml Bleeding due to thrombocytopenia or thrombocytopathy Same as platelets.0 x 1011/unit). RBCs.5 x 1010/unit).l sometimes HLA matched Platelets Pheresis 300 ml Platelets Leukocytes Platelets (as above).0 x 1010 PMN/unit). second choice in treatment of hemophilia A. WBCs. plasma Platelets (> 3 x 1011). Factors VIII and XIII.

Willebrand’s disease (off-label use for selected products only) 25 ml Hemophilia B (Factor IX deficiency) (5%). preparations for IV and/or IM use Antithrombin Antithrombin. Blood Components and Plasma Derivatives Component/Product Composition Factor VIII Factor VIII. CMV = cytomegalovirus. trace amount of other plasma proteins 10 ml RBCs = red blood cells. (25%) Volume expansion Immune Globulin IgG antibodies preparations for IV and / or IM use varies Treatment of hypo-or agammaglobulinemia. IM = intramuscular . PMN = polymorphonuclear cells. disease prophylaxis. IV = intravenous.Table 1. plasma proteins (products vary Recombinant human in purity) Factor VIII) Factor IX (concenTrates. some -. Hct = hematocrit. WBCs = white blood cells. PPF = plasma protein fraction. treatment of autoimmune thrombocytopenia Treatment of antithrombin deficiency Rh Immune Globulin IgG anti-D. ß-globulins Volume 25 ml Indications Hemophilia A (Factor VIII deficiency). trace amount of other plasma proteins (products vary in purity) Albumin. autoimune thrombocytopenia (IV only) 1 ml Prevention of hemolytic disease of the newborn due to D antigen. trace amount of other (consentraes. FFP = fresh frozen plasma. recombi Nant human Factor IX) Albumin/PPF Factor IX.

golongan darah pasien = donor ? (tanyakan/peneng) .PEMBERIAN TRANSFUSI DARAH • Nilai ulang: .identitas donor dan gol drh donor  label merah muda.check list pelaksanaan transfusi darah .identitas pasien tepat ? . putih. kuning .awasi reaksi transfusi darah .awasi selama dan setelah transfusi (tanggung jawab dokter) . biru muda.

Indikasi Penggantian faktor – faktor Hemostatik pada Pasien Trauma -Tentukan status koagulasi pasien.Pedoman klinis : * luas dan lokasi perlukaan * lama renjatan berlangsung * respon terhadap resusitasi awal * risiko komplikasi.Pedoman untuk komponen darah spesifik : Berikan transfusi  * trombosit : bila jumlah trombosit < 80 – 100 x 109/L * FFP : bila masa protrombin / masa tromboplastin parsial > 1. misalnya perdarahan intrakanial .Ganti komponen darah untuk memperbaiki kelianan spesifik . bila mungkin dengan tes laboratorium yang tepat .5 x normal * Kriopresipitat : bila kadar fibrinogen < 10 g/L .

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®) .

kecuali pada keadaan tertentu .1 unit meningkatkan 5000/mm3 (dewasa 70 kg) . tak perlu cross match.dosis umumnya: 1 unit per 10 kg BB (5-7 unit untuk orang dewasa) .KEBUTUHAN TROMBOSIT • Trombosit: .ABO-Rh typing saja.

m2 N = number of units of platelet concentrates transfused. each > 0.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 = recipient’s body surface area.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 .37º C) harus segera ditransfusikan • ABO-Rh typing saja (tak perlu cross match) .

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 • Dosis untuk pasien hemofilia: rumus .

eg. fever. induce & recipient diuresis. hemolysis. coagulati proper sample on profile. Avoid clerical hydrate. no acute & recipient treatment generally identification required Stop transfusion. rarely hypotension Antibodies to leukocytes or plasma protein. ensure blood pressure & proper sample respiration. chill. give antipyretic. (immune) increased urine urobilinogen. DIC. support errors. shock. (immune) chills. anxiety. leukocytereduced blood if recurrent Febrile Fever. Acute Transfusion Reactions (1) Type Sign and Symptoms Usual Cause Treatment Prevention Intravascular Hemoglobinemia and hemolytic hemoglobinuria. if present Monitor Ht. Avoid clerical renal & hepatic error : ensure function. acetaminophen . treat shock and DIC. Commonly due to patient’s underlying condition (continued) . for rigors Use meperidine 2550 mg IV or IM Pre transfusion antipyretic. chest pain. flank pain. oliguria identification Extravascular Fever.Table 5. malaise. sepsis. indirect Hemolytic hiperbilirubinemia. dyspnea. falling hematocrit ABO incompatibility (clerical error) or other complement – fixing antibody causing antigen – antibody incompatibility IgG non-complementfixing antibody often assoclated with delayed hemolysis Stop transfusion. passive cytokines infusion.

if severe. epinephrine and/or steroids Pre-transfusion antihitamine. phlebotomy. if recurrent or severe check pretransfusion IgA levels in patients with a history of of anaphylaxis to transfusion Hypervolemic Dyspnea.give.Table 5. hypertension pulmonary edema. washed RBC components. rarely anti. rarely To severe) hypotension or anaphylaxis Antibodies to plasma Stop transfusion. antihistamine bodies to IgA (PO or IM). Acute Transfusion Reactions (2) Type Sign and Symptoms Usual Cause Treatment Prevention Allergic (mild Urticaria (hives). cardiac arrhytmias Too rapid and/or excessive blood transfusion Induced diuresis. proteins. support cardiorespiratory system as needed Avoid rapid or excessive transfusion (continued) .

culture patient and blood unit. fever pulmonary edema.Table 5. hypotension. support blood pressure. fever. shock Contaminated blood component Stop transfusion. notify blood transfusion service DIC = disseminated intravascular coagulation. normal pulmonary capillary wedge pressure HLA or leukocyte Support blood antibodies. Acute Transfusion Reactions (3) Type Sign and Symptoms Usual Cause Treatment Prevention Transfusionrelated acute lung injuri (TRALI) Dyspnea. IV = intravenous. IM = intramuscular. chills. give antibiotics . usually pressure and donor antibody respiration (may transfused with require intubation) plasma in compo nents Leukocyte-reduced RBCs if recipient has the antibody.RBC = red blood cells . PO = by mouth. careful attention to armpreparation for phlebotomy Bacterial sepsis Rigors. notify transfusion service to quarantine remaining components from donor Care in blood collection and storage.

Monitor renal status (BUN. Shattil SJ. In : Hoffman R. Monitor coagulation status (prothrombin time. 9. Initiate a diuresis 12. 2. Monitor for sign of hemolysis (lactate dehydrogenase. 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. Repeat compatibility testing (cross match) 16. If sepsis is suspected. 3. 8. fibrinogen. 5. et al. 4. culture unit and patients. EF Jr. partial tromboplastin time. Benz. Ney York : Chruchill Livingstone. bilirubin. creatinine) 11. 2nd ed. 7. 6. haptoglobin. 2045-53 .Table 4. Evaluate plasma for hemoglobinemia c. Perform direct antiglobulin set d. Transfusion reaction. and treat as appropiate Adapted from snyder EL. 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. platelet count) 14. Hematology : Basic Principle and practice. Analyze urine for hemoglobinuria 13. Repeat other serologic testing as needed (ABO/RH) If intravascular hemolytic reaction in confirmed 10. Workup of an Acute Transfusion Reaction If an acute transfusion reaction occurs : 1. 1995 . plasma hemoglobin) 15. Check paper work to ensure correct blood component was transfused to the right patient b.