PRINSIP PRINSIP TRANSFUSI

DARAH
 Tranfusion Complications

Can be prevented Can be fatal

E.g: E.g:
• Hemolytic reactions: • Acute / Intra vascular
Intra- & extra- vascular hemolytic reactions
 Screening: ABO- Rh • Anaphylactic reactions
typing • Transfusion Related
 cross matching Acute Lung Injuri (TRALI)
• Transfusion
transmissible infections
 screening of Hepatitis B,
hepatitis C, HIV, syphilis
Despite screening for
• Avoid clerical errors
prevention 
(adminitration errors)
COMPLICATIONS ++
and RISK of
COMPLICATIONS >>
RISKS OF NON-INFECTIOUS COMPLICATIONS
Reaction (Selected) Risk
Fever without hemolysis 1:100 – 1:200

TRALI 1:5000 -1:7500

Acute Hemolysis 1:6000 (1:500,000 are fatal)

Alloimmunization; serologic, 1:1500

delayed hemolysis
Alloimmunization; clinically 1: 4000
symptomatic, delayed hemolysis
BLOOD TRANSFUSION COMPLICATIONS
• ACUTE Blood Transfusion Reaction:
- intravacular hemolysis (hemodynamic disturbance,
respiration, acute renal failure, DIC)
- fever, allergy
- hypervolume, transfusion related acute lung injury
(TRALI)
- sepsis bacteria, etc

• LATE Blood Tranfusion Reaction: extra vascular hemolysis,

TTI (transfusion transmissible infection), etc

• COMPLICATIONS: - can be PREVENTED

- can be FATAL
INFORMATION AND INFORMED CONSENT

• SHOT (Serious Hazard of Transfusion)

• Prior to transfusion:
- information to patients / families:
risks >< benefits
- informed consent  let the patient choose &
determine the blood transfusion him-/her- self
SERIOUS HAZARD OF TRANSFUSION (SHOT):
OVERVIEW OF 618 CASES: INITIAL REPORTS FORMS WERE RECEIVED
1996 – 1999 (UNITED KINGDOM)
• Incorrect blood/components transfused 335 (54,2 %)
• Acute transfusion reaction 89 (14,4 %)
• Delayed transfusion reaction 82 (13,3 %)
• Post transfusion purpura 32 (5,2 %)
• Transfusion related acute lung injury (TRALI) 43 (7%)
• Transfusion-associated graft versus host disease 11 (1,8%)
• Transfusion transmitted infection 19 (3 %)
• Unclassified 7 (1,1 %)
APPROPRIATE USE OF
BLOOD / BLOOD PRODUCTS (COMPONENTS)

3. Blood donated by family/replacement

donors carries a higher risk of TTI
than blood donated by voluntary
non-remunerated donors

4. Blood should not be transfused unless

it has been obtained from
appropriately selected donors
SCREENING TEST FOR TRANSFUSION TRANSMITTED
INFECTIONS (TTI)

• Indonesia: HBsAg, anti HCV, anti-HIV,

anti-syphillis
• UK: Mandatory: HBsAg, anti-HCV, anti HIV-1
anti HIV-2, anti-siphillis,
Optional : anti CMV, malaria
• USA, Japan, some coutries in Eropa:
+ HTLV
+ antigen B 19 (Jepang)
KESALAHAN PEMBERIAN DARAH DONOR YANG
INKOMPATIBILTAS KEPADA PASIEN 
REAKSI HEMOLISIS AKUT YG DAPAT FATAL.
UMUMNYA DISEBABAKAN OLEH FAKTOR :

 CLERICAL ERROR
= ADMINISTRATION ERROR
= HUMAN ERROR

Pemberian transfusi darah yang

aman di rumah sakit 
Professonalisme
REAKSI HEMOLITIK AKUT
• Syok, hipotensi , bronkospasme :
diproduksinya fragmen komplemen anafilaktoksin C3 dan C5, serta mediator
inflamasi
• Iskemia ginjal  “Acute tubular necrosis” (ATN)  Gagal ginjal, karema NO (nitric
oxide) berikatan dengan Hb bebas
• Kaskade koagulation diaktifkan  DIC

• Gejala dan tanda klinik umunya disebabakan oleh aktivasi “network” sitokin: IL-
1, IL-6, IL-8, TNF α  febril , hipotensi , aktivasi leukosit dan kaskade koagulasi
KOMPLIKASI TRANSFUSI
(APAKAH REAKSI HEMOLITIK AKUT ?) :
APA YANG HARUS DIKERJAKAN?

• Setelah transfusi distop  Tentukan: Apa jenis komplikasinya?

Klinik & laboratorium?
1. Observasi VITAL STATUS: TD, Nadi, RR, suhu
 syok?  siapkan emergency kit  dukungam tekanan darah
 obati syok
2. Observasi Jalan nafas perlu ventilator ?
3. Nilai DIURESIS (urin output)  gagal ginjal?  perlu HD ?
4. DIC (+)  perdarahan atau trombosis ?  obati DIC
Table Workup of an acute transfusion reaction (1)
If an acute transfusion reaction occurs
1. Stop blood component transfusion immediately
2. Verify the correct unt 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 and pulse
5. Maintain adequate ventillation
6. Notify attending physician and blood bank
7. Obtain blood / urine for transfusion reaction workup
8. Send report of reaction, samples, blood bag, and
administration set to blood bank
9. Blood bank performs workup of suspected transfusion
reaction as follows :
A. A clerical check is performed to ensure correct blood
component was transfused to the right patient
B. The plasma is visually evaluated for hemoglobinemia
C. A direct antiglobulin test is performed
D. Other serologic testing is repeated as needed (ABO, Rh, crossmatch)
Table Workup of an acute transfusion reaction (2)
If intravascular hemolytic reaction is confirmed :
1. Monitor renal status (BUN, creastinine)
2. Initiate diuresis; avoid fluid overload if renal failure is
present
3. Analyze urine for hemoglobinuria
4. Montor coagulation status (D-dimer, PT, aPTT, fibrinogen,
platelet count)
5. Monitor for signs of hemolysis (LDH, bilirubin, haptoglobin,
plasma
hemoglobin)
6. Monitor hemoglobin and hematocrit
7. Repeat compatibility testing (crossmatch)
8. Consult with blood bank physician before further transfusion
Table Workup of an acute transfusion reaction (3)
If bacterial contamination is suspected :

1. Obtain blood culture of patient

2. Return unit or empty blood bag to blood bank for culture

and Gram’s stain

3. Maintain circulation and urine output

4. Initiate broad-spectrum antibiotic treatment as appropriate:

revise antibiotic regimen on the basis of microbiological
results

5. Monitor for signs of DIC, renal failure, respiratory failure