DHF bleeding

8/13/2019 DHF bleeding

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INFEKSI

DENGUEASIMTOMATIK

SIMTOMATIK

TANPAPERDARAHAN

DENGAN

PERDARAHAN

TIDAK MASSIF

SYOK TANPA SYOK

MASSIF


3/20

Average annual number dengue fever (DF) and denguehaemorrhagic fever (DHF) cases reported to WHO, and of

countries reporting dengue, 1955-2007


4/20

Dengue guidelines for diagnosis, treatment, prevention, and control. World Health Organization, UNICEF,

UNDP. New Edition 2009.


5/20

Trombosit

Kompleks

Ag-Ab

Trombosit

dihancurkan

Agregasi

terganggu

Perdarahan

Permeabilitas

Kapiler

Mediator


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Manifestasi : Perdarahan pada DBD

Tes Rumpel positif

Epistaksis

Haemoptoe

Perdarahan gusiPerdarahan sal. Makanan

Hematuria

Hipermenore


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Grading The Severity of DHF

Grade I:

Fever accompanied by non-specific constitutional symptoms; the onlyhemorrhagic manifestation is a positive tourniquet test.

Grade II:

Spontaneous bleeding in addition to the manifestations of Grade I

patients, usually in the form of skin and/or other hemorrhagic. Grade III:

Circulatory failure manifested by rapid and weak pulse, narrowing of

pulse pressure (20 mmHg or less )or hypertension, with the presence ofcold clammy skin and restlessness

Grade IV:

Profound shock with undetectable blood pressure and pulse


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Massive bleeding s usually from :

Gastrointestinal tract,

Vagina inadult females.

Internal bleeding may not become apparent for many hours

until the firstblack stool is passed.

WHO 2009


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Have prolonged/refractory shock;

Hypotensive shock and :

Renal

Liver failureSevere andpersistent metabolic acidosis

Given non-steroidal anti-inflammatory agents

Pre-existing peptic ulcer disease

On anticoagulant therapyHave any form of trauma

including intramuscular injection.

WHO 2009

Patients at risk of major bleeding


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WHO 2009

Severe bleeding can be recognized by:

Persistent and/or severe overt bleeding +unstable

haemodynamic status

Haematocrit after fluid resuscitation +

unstablehaemodynamic status

Refractory shock that fails to respond to

consecutive fluid resuscitation of40-60 ml/kg

Hypotensive shock with low/normal haematocrit before

hypotensive shock

Persistent or worsening metabolic acidosis


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Give 510ml/kg of fresh-packed red cells

or 1020 ml/kg of fresh wholeblood at an appropriate rate

observe the clinical response.

A good clinical responseImproving haemodynamic status

Acid-base balance.

WHO 2009

Consider repeating the blood transfusion if :

Further blood loss or

Noappropriate rise in haematocrit after blood transfusion

The action plan for the treatment of

haemorrhagic complications :


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Penatalaksanaan Perdarahan Spontan

Perdarahan Spontan dan Masif: - Epistaksis tidak terkendali

- Hematemesis melena- Perdarahan otak

Bila Hct < 30 %Transfusi PRC segar 5 10 ml/kgBB

Atau WBC Segar 10 20 ml/kgBB

Transfusi komponen darah :* FFP (bila APTT > 1,5 X normal )

* Trombosit (bila Tromb.


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Tatalaksana Syok HipotensifInfus Kristalloid/Kolloid 20 ml/kgBB selama 15 menit

PERBAIKAN

TETAP SYOK

Kolloid 10-20 ml/kgBB

Selama - 1 jam

Ht k

Transfusi PRC

10 ml/kgBB

Ht k

TETAP SYOK

Kristalloid7 10 ml/kgBB

1 2 jam

WHO 2010

PERBAIKAN

PERBAIKAN

Kristalloid5 7 ml/kgBB

1 2 jam

Kristalloid3 5 ml/kgBB2 4 jam

PERBAIKAN

Kristalloid 2 3 ml/kgBB2 4 JAM TURUNKAN


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Kasa basah, darah segar merembes


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Perdarahan hebat akibat DIC pada DSS


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DHF bleeding

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