Reaksi Transfusi dan

Penatalaksananya
Frekuensi reaksi Transfusi
 Mengapa kita harus mengawasi
selama transfusi komponen darah ?
 Problem Administrasi
 Reaksi demam ( < 24 jam)
 Reaksi Allergi (< 24 jam)
 Reaksi Hemolitik Akut (< 24 jam)
 Kontaminasi Bakteri
 Transfusion-associated circulatory overload
(TACO)
 Transfusion-related acute lung injury (TRALI)
 Delayed haemolytic reaction ( > 24 jam)
 Purpura Post-transfusi
 Transfusion-associated graft-versus-host
disease
Kapan kita melakukan
observasi?
Yang mana hasil observasi yang bisa
di dokumentasikan
 Apa tanda dan gejala yang harus
diperhatikan
 perasaan demam, hangat atau lembab
 menggigil
 sesak nafas
 kelelahan Extreme tiredness
 darah di urin
 Pembekakan
 gatal pada kulit
 nyeri pada punggung
 memar yang tidak dapat dijelaskan
 Ikterik
 Mual dan Muntah
Overview Serious
•Akut hemolitik
•Delayed hemolitik
• reaksi Anafilaksis
•Transfusion Associated Circulatory Overload
(TACO)
•Transfusion Related Acute Lung Injury (TRALI)
•Kontaminasi Bakteri
Uncomfortable, not serious
•Allergic
•Febrile non-hemolitik
•Hypotensi
Acute Hemolytic Transfusion Reactions (AHTR)
•Patofisiologi:
- ABO incompatibilitas
- Mislabeled blood sample
- Kesalahan identifikasi pasien
- Hemolisis Intravascular
– IgM - ABO antibodies
•Incidensi: ~1 in 100,000 transfusi
•60% fatal
AHTR recognition
•Onset : dalam 10-15 menit
• tanda dan gejala : fever, menggigil
nausea/vomiting, abdominal pain,
headache, dyspnea, hypotensi,
tachycardia
•Labs: DAT positive, urine hemosiderin
later
Delayed Hemolytic Transfusion Reactions
(DHTR)
•Pathophysiology:
–Antigens lain dari sistem ABO
–Extravascular hemolysis
–Alloantibody (IgG) stimulasi
•Undetectable
•Insidensi: 1 in 7,000 transfusi
•Jarang Fatal
DHTR Recognition
•Hours to days after transfusion
•S & S: Typically patient feels fine
•Labs: Positive DAT, drops in H & H
 Delayed hemolisis Hemolisis akut
reaksi transfusi reaksi transfusi
Onset gejala : 5-10 Gejala tiba-tiba
hari sesudah transfusi.  intravascular hemolisis,
Hemolitik, anemia, hipotensi,demam, AKI.
jaundice, demam. DIC, pink plasma/urine
Komplikasi yang  terapi : stop transfusi
mengancam  blood  bank darah
kehidupan jaran  incompatibili
dilakukan. hemolisis
detect alloantibody  terapi suportif : IVF,
 terapi : supportive pressors, diuresis
Reaksi Alergi dan
Anaphylaxis
Urticaria >>  multiple transfusi
Pencegahan : riwayat alergi, anti histamin,
WRC produk .
Severe anaphylaxis : jarang
Mechanism: anti-IgA antibodies bereaksi
dengan IgA pada donor
Pencegahan: WRC
Mengetahui reaksi Anaphylaxis
•waktu : early onset, menit
• tanda dan gejala :
- Hypotension, edema, dyspnea,
stridor, wheezing, cramping, diarrhea,
shock, loss of consciousness
•No fever or chills
•Lab : DAT negative
Anaphylaxis
•Pathophysiology: Anaphylatoxins menghasilkan
mediator-mediator sekunder aktifasi
complemen
•Incidensi: Uncommon, 1:20-50,000 transfusi
• dapat berakibat fatal
Anaphylaxis Reaction Prevention
•washed RBCs
•Steroid premedikasi
•Rekuren , not predictable
Febrile Nonhemolytic Transfusion
Reactions (FNHTR)
•Pathophysiology: sitokin yang berasala dari
donor , tidak berulang (product dependent)
atau antibodi lekosit pasien
 recurrent (patient dependent)
• Incidensi : paling common
– 1% dari tindakan RBC transfusi
– 30% dari platelet transfusi
–  dengan leukoreduction
• Uncomfortable but not fatal
FNHTR Recognition
• waktu : the end of transfusion
• tanda dan gejala : temperature > 1 °C*,
chills, rigors, headache, nausea, vomiting,
hypertension, tachycardia, dyspnea
•Lab: DAT negative
* Can be masked by premedication
 Febrile Nonhemolytic Transfusion
Reaction

 demam  kerap terjadi saat transfusi

 Patofisiologi : antibodi leukoreaktif
resipien sitokin yang berasal dari donor.
 tatalaksana : stop transfusi
 Pencegahan : antipyretik atau
leukoreduction dari produk darah.
Acute Hypotensive Reactions
•Pathophysiology: ACE inhibitors often
associated
–Multiple factors create risk
•Genetic variability in BK metabolism
•Negatively charged filters
•Contact system activation in product
•BK receptor induction
•Incidence: ???
•Significance: Recovery generally rapid
Acute Hypotensive Reactions
•Timing: Rapid onset (minutes)
•S & S: Hypotension, lightheadedness,
anxiety
–Rarely nausea, dyspnea, flushing, hives
–No fever, chills, wheezing, edema
–Rapid recovery once transfusion stopped
•Labs: DAT negative
Transfusion-Associated
Circulatory Overload (TACO)
 Faktor Risiko
Pasien dengan cadanagn fungsi
kardiopulmonal
High volume transfusi
Histori peny jantung or ginjal
 Onset: 1-2 jam sesudah transfusi
 gejala : sesak nafas,batuk,takikardi,sianosis,
volume overload ( S3 gallop, edema perifer)
 Thy: O2, diuretik
 pencegahan : Pemberian yang lambat,
diuretik pre transfusi
Transfusion Associated Circulatory Overload
(TACO)
•Pathophysiology: Rapid intravascular volume
expansion, depends on rate/volume of
transfusion
•infants and elderly
•Incidensi: 1 in 350-5,000
•CHF dapat berakibat fatal
TACO
•Timing: bervariasi tergantung pemberian
cairan
• gejala dan tanda: Dyspnea, orthopnea,
cyanosis, cough, JVD, CHF, tachycardia,
hypertension, headache, responds to diuresis
•Labs: Elevated BNP
•Terapi seperti CHF, space transfusions over
time
 Transfusion-Related Acute Lung
Injury (TRALI)

Onset: dalam 6 jam

transfusi
Gejala : hipoksia,
dyspnea, fever,
hipotensi,edema paru
Treatment: stop transfusi
Suportif : O2
Prevention:
pemberitahuan  blood
bank

thelancet.com
 TRALI

 TRALI Donor factors: Anti-

HLA antibodies in plasma
 Chemokines released
during product storage
 Recipient’s underlying
disease state
 Recruitment of
neutrophils in small vessels
of lung
 infiltrates
TRALI
•Incidensi: ??? 1 in 1,300 to 190,000
•Significance: Usually resolves, but can be
fatal
TRALI :
•Timing: Later in transfusion, high plasma
content products
•tidak respon dengan diuretik, diuretik akan
memperburuk keadaan
•Labs: DAT negative
TRALI versus TACO

Kim et al. 2015.

Apa yang dilakukan bila pasien
mempunyai reaksi transfusi ??
Terima Kasih