Alamsyah --Fluids Theraphy Dan Komponen Darah PALEMBANG

7/29/2019 Alamsyah --Fluids Theraphy Dan Komponen Darah PALEMBANG

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Intravenous Fluid Therapyand Blood Component

MUHAMMAD ALAMSYAH


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Fluid Compartments

Total body consists of60% water byweight in adults

Body fluids divided into: Intracellular compartment Extracellular compartment, further

divided into:

Interstitial compartmentIntravascular compartment


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Intracellular Fluid

Intracellular Fluid 2/3

Extracellular Fluid1/3

InterstitialFluid=75%

IntravascularFluid=25%

Fluid Compartments


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Consists of: Cellular components of blood Proteins Ions mainly sodium, chloride andbicarbonates Potassium only a small portion in plasma

Normal blood volume is about 72 mL/kg of bodyweight

Intravascular compartement


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Larger than intravascular compartment Water and electrolytes pass freely between blood

and interstitial spaces, which have similar ioniccomposition

Plasma proteins are not free to pass out of theintravascular space unless there is damage tocapillaries, e.g., septic shock or burns

With fluid loss or fall in blood pressure, water andelectrolytes pass from interstitial compartmentinto blood (intravascular) to maintain volume(physiologic priority)

Interstitial compartement


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Water within cells: Largest reservoir of body water Ionic composition different from extracellular fluid Contains high concentration of potassium ions and

low sodium and chloride ions Normal saline given IV: Tends to remain inextracellular compartment

Glucose solution gets distributed throughout allbody compartments Pure water given IV: Causes massive hemolysis(dangerous)

Intracellular Compartement


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Fluid replacement should be as close as possiblein volume and composition to those fluids lost

Acute losses should be replaced quickly

Chronic lossesreplace with caution; rapidinfusion may cause fluid overload and heartfailure Better replaced by oral or rectal rehydration

Mostly deficient in water: Do not overload withsodium

Principles of Fluid Therapy


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Use salt solution Normal saline or Ringerslactate

Preload 1 L before spinal anesthesia

Ketamine anesthesia does not need preloading Maintenance fluid 4mL/kg/hour

Fluid Therapy DuringOperation


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Replacement for the loss of fluid Blood loss replace with crystalloid 3 times the

volume of blood loss Blood loss more than 1 L consider giving

blood Desirable to have a hemoglobin minimum

89 mg after surgery

Intravenous FluidTherapy

Fluid Therapy DuringOperation


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Subjective Fully soaked and dripping mop approximately

100 mL

Monitor heart rate, blood pressure throughout theoperation

Urine output 0.5 mL/kg/hr considered adequatefluid replacement

Estimation of Blood Loss


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Crystolloids 5% dextrose in aqua 5% dextrose in NaCl Normal saline (NaCl) Hartmans solution Ringers lactate solution Cholera saline

Colloids Dextran 40, 70 Gelatin preparations e.g., Haemacel Hetastarch, Pentastarch

Intravenous FluidTherapy

Types of IV Fluids


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TRANSFUSI DARAH


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Nilai ulang:- check list pelaksanaan transfusi darah- golongan darah pasien = donor ?(tanyakan/peneng)

- identitas pasien tepat ?- identitas donor dan golongan darah donor- awasi selama dan setelah transfusi(tanggung jawab dokter)

- awasi reaksi transfusi darah

Pemberian Transfusi DarahPada Pasien


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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 labileclotting Factors V and VIII)

Red Blood Cells RBC (approx. Hct 75%); reduced 250 ml Increase red cell mass in symptom

plasma, WBCs, and platelets atic anemia (WBCs & platelets not

functional)

RBCs Leukocytes > 85% original volume of RBC; 225 ml Increased 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

(Continued)


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Component/Product Composition Volume Indications

Platelets Platelets (> 5.5 x 1010/unit); 300 ml Bleeding due to thrombocytopenia or

RBC; WBCs; plasma thrombocytopathy

Platelets Pheresis Platelets (> 3 x 1011); 300 ml Same as platelets;l sometimes HLARBCs; WBCs; plasma matched

FFP; FFP Donor Plasma; anticoagulation factors; 220 ml Treatment of some coagulatioRetested 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 Willebrands disease

(Continued)

Table 1. Blood Components and Plasma Derivatives (1)


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Trombosit disimpan dalam kondisi digoyang terus(Reciprocal agitator), pada suhu kamar (20C)

Harus segera diberikan (tidak boleh disimpan dikulkas/ di ruangan)

Kecepatan cepat Gunakan infus set khusus (jangan menggunakan

set transfusi darah merah)

Transfusi Trombosit


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Trombosit:- dosis umumnya: 1 unit per 10 kg BB(5-7 unit untuk orang dewasa)

- 1 unit meningkatkan 5000/mm3(dewasa 70 kg)- ABO-Rh typing saja, tak perlu cross

match, kecuali pada keadaan tertentu

Kebutuhan Trombosit


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KEBUTUHAN PLASMA/FFP

Dosis bergantung kondisi klinis dan penyakitdasarnya

Coagulation factor replacement:10 20 ml/kg BB (= 4-6 unit pd dewasa)

Dosis ini diharapkan dapat meningkatkan faktorkoagulasi 20 % segera setelah transfusi

Plasma yang dicairkan (suhu 30 - 37 C) harussegera ditransfusikan

ABO-Rh typing saja (tak perlu cross match)

Transfusi Plasma / FFP


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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

Transfusi Kriopresipitat


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REAKSI REAKSITRANSFUSI DARAH

Bila dilaksanakan pemeriksaan laboratoriumsebelum pemberian transfusi darah, mayoritastransfusi darah tidak memberikan efek sampingkepada pasien

Namun, kadang-kadang timbul reaksi padapasien, walaupun pemeriksaan laboratorium pra-transfusi darah telah dilaksanakan dan hasilnyaCOMPATIBLE(= cocok antara darah resipien dan donor)

Reaksi: reaksi RINGAN (suhu meningkat, sakitkepala) s/d BERAT (reaksi hemolisis), bahkandapat meninggal

Reaksi Transfusi Darah


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KOMPLIKASI TRANSFUSIDARAH

Komplikasi LOKAL:- kegagalan memperoleh akses vena- fiksasi vena tidak baik- masalah ditempat tusukan

- vena pecah saat ditusuk, dll

Komplikasi UMUM:- reaksi reaksi transfusi

- penularan/transmisi penyakit infeksi- sensitisasi imunologis- kemokromatosis

Komplikasi Transfusi Darah


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REAKSI TRANSFUSI DARAH

Reaksi Tranfusi Darah AKUT:hemolitik, panas, alergi, hipervolume,

sepsis bakteria, lung injury, dll

Reaksi Transfusi Darah LAMBAT



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REAKSI REAKSITRANSFUSI DARAH

Yang paling sering timbul:- reaksi febris

- reaksi alergi- reaksi hemolitik



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REAKSI FEBRIS

Nyeri kepala menggigil dan gemetartiba tiba suhu meningkat

Reaksi jarang berat Berespon terhadap pengobatan

REAKSI FEBRIS


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REAKSI ALERGI

Reaksi alergi berat (anafilaksis): jarang

Urtikaria kulit, bronkospasme moderat,edema larings: respon cepat terhadappengobatan

REAKSI ALERGI


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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


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REAKSI HEMOLITIK

REAKSI INTRAVASKULAR:- hemolisis dalam sirkulasi darah- jaundice dan hemogolobinemia

- antibodi IgM- paling bahaya anti-A dan anti-B spesifikdari sistem ABO

- fatal akibat perdarahan tidak terkontrol

dan gagal ginjal

REAKSI HEMOLITIK


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REAKSI HEMOLITIK

REAKSI EKSTRAVASKULAR:- jarang sehebat reaksi intravaskular- reaksi fatal jarang

- disebabkan antibodi IgG destruksieritrosit via makrofag

- menimbulkan penurunan tiba triba

kadarHb s/d 10 hari pasca transfusi

REAKSI HEMOLITIK


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Alamsyah --Fluids Theraphy Dan Komponen Darah PALEMBANG

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