Transfusi Darah Uns

8/18/2019 Transfusi Darah Uns

1/33

TRANSFUSI DARAH

M.I. Diah Pramudianti

BAGIAN/SMF PATOLOGI KLINIK

RSUD DR MOEWARDI/FK UNS

SURAKARTA

2!2


2/33

PENDA"ULUAN

• Tran#$u#i darah % #a&ah #atu t'ra(i

('nun)an* +an* i,ut m'n'ntu,an

,'-'rha#i&an ('nan*anan (a#i'n +an*

m'n*a&ami ,',uran*an #a&ah #atu/&'-ih,m(n'n darah &'h ,ar'na

('n+a,it/#'-a- &ainn+a.

•P'r&u ('n+'diaan darah +an* ra#ina& danaman ,hu#u#n+a (ada ,a#u#,a#u#

an'mia/('rdarahan

•

S,r''nin* dnr % "-#A*0 Anti "10 DRL0


3/33

TU3UAN TRANSFUSI DARA"

• M'n**anti darah/,m(n'n darah +an*

hi&an*/m'n*a&ami ('nurunan

,uantita#/,ua&ita#.

• M'm('r-ai,i tran#(rta#i O2 ,' )arin*an• M'm('r-ai,i *an**uan ('rdarahan ,

,',uran*an trm-#it•

M'ru(a,an t'ra(i ('nun)an* ,a*u&a#i ,,',uran*an (rt'in ('m-'ntu, $a,tr

('m-',uan


4/33

TRANSFUSI DARA"

• Prdu, darah +an* di-'ri,an %

A.Whole blood % -'ri#i #'mua ,m(n'n

darah &'n*,a(

B.Km(n'n darah % #udah m'n*a&ami('mi#ahan untu, m'm('r&'h ,m(n'n

darah +an* di-utuh,an.


5/33

"EMAFERESIS

• Pr#'dur ('n*am-i&an darah dari

#'#'ran* dimana ,m(n'n darah +an*

di('r&u,an diam-i& dan +an* tida,

di('r&u,an dima#u,,an ,'m-a&i ,' ran*

t'r#'-ut.

A. Sit$'r'#i# % 'ritr#it$'r'#i#0

&'u,#it$'r'#i#0 trm-#it$'r'#i#

B. P&a#ma$'r'#i#


6/33

Uji kompatibilitas pre transfusi

• Km(n'n u)i ,m(ati-i&ita# %

–P'r#ia(an #('#im'n +an* m'madai

–

Ri4a+at tran#$u#i (a#i'n #'-'&umn+a – ABO0 Rh0 dan t'# anti-di

5#,r''nin*/ID6

–

Crossmatching 5r'a,#i ,'77,an#i&an*6 % ma+r/minr

– 1m-8# t'#t

–Tran#$u#i #'-'narn+a


7/33

PEMERIKSAAN SER!"I "!N"AN

DARAH PRA TRANSFUSI

• P'm'ri,#aan *&n*an darah ABO 2 7ara%

1'&& *ru(in* % ada/tida,n+a anti*'n A/B

di ('rmu,aan 'ritr#it

S'rum *ru(in* 5-a7, t+(in*6 % ada/

tida,n+a anti-di A0 B0 AB di #'rum/

(&a#ma

• P'm'ri,#aan *&n*an darah Rh'#u#%

han+a anti*'nD / Du (ada 'ritr#it


8/33

Sistem #olon#an $ara% eritrosit utama pa$a manusia

Tahun

dit'mu,an

!9!

!92:

!92:

!9;!9;<

!9;:

!9;:

!9!9t6

?*

Dm-r7, 5D6

1&tn 516

S7ianna 5S76

Anti*'n utama

(ada 'ritr#it

"0A0B

M0N0S0#

P!0(

D010E070'

Lua.Lu-

K0,0K(a0K(-0K(703#a03#-

L'a0L'-

F+a0F+-

3,a03,-

Dia

0Di-

>ta0>t-

?*a

Da0D-

1a01-

S7!0S72

Anti-di tim-u&

#'7ara a&amiah

S'&a&u

Ta,

Kadan* @ ,adan*

Ta,

Ta,

Ta,

Kadan* @ ,adan*

Ta,

Ta,

Ta,

Ta,

Ta,

Ta,

Ta,

Ta,


9/33

"olon#an $ara% A&

F'nti(

O

A!

A2

B

A!B

A2B

G'nti(

OO

A! A!

A!O A! A2

A2 A2 A2O

BB

BO

A!B

A2B

Anti*'n

'ritr#it

"

A A!

A "

B 5"6

A A! B

A B 5"6

Anti-di

#'rum

AntiA

AntiB

AntiB

AntiB

5Anti A!6

AntiA

tida, ada

5Anti A!

6

Fr',u'n#i

Kau,a#ia Ori'nta&

;<

;: C

;= 22

!


10/33

!

”Transfusion rules for RBC “di dalam sistem ABO

Pada transfusi RBC, antara eritrosit donor & plasma resipien

harus terdapat compatibilitas ABO & Rh1.Grup O hanya dapat menerima darah dr donor grup O

.Grup A hanya dapat menerima darah dr donor grup A & O

!.Grup B hanya dapat menerima darah dr donor grup B & O

".Grup AB dapat menerima darah dr donor grup AB, A, Bdan O

O # donor uni$ersalAB# resipien uni$ersal

Sa$'t+ -i&am'mun*,in,an han+a 'ritr#it

dnr d'n*an *& ABO +an*

#ama d'n*an ('nd'rita #a)a

+an* di-'ri,an


11/33

“Transfusion rules for plasma “ di dalam sistem ABO

Pada transfusi plasma, plasma grup AB dapat diberi%an

pada setiap penderita grup ABO o.% tida% mengandungAnti A & Anti B

1. Plasma grup AB Antibodi '( dpt diberi%an %e semuagrup ABO

. Plasma grup AAnti B )( dpt diberi%an %e resipiengrup A & O

!. Plasma grup B Anti A )( dpt diberi%an %e resipiengrup B & O

". Plasma grup O *Anti A )( & Anti B)(+ hanya dapatdiberi%an %e resipien grup O


12/33

R'a,#i #i&an*

A. Ma+r % #'& darah dnr #'rum ('nd'rita

B. Minr % #'rum dnr #'& darah ('nd'rita

Bi&a ha#i& ('m'ri,#aan%

Ma+r 56 % tida, -i#a tran#$u#i0 #'-a- tit'r r'a,#i

anti-di dnr t'ta( tin**i #'hin**a #'rum

dnr da(at m'&i#i#,an 'ritr#it r'#i(i'nMinr 56 % da(at ditran#$u#i,an0 #'-a- ('n+'-a-

in,m(ati-i&ita# dari dnr.


13/33

'rossmat(%

)major*RESIPIENT DONOR

&loo$

spe(imen

)no anti(oa#ulant*

! unit$

-&d

Re(ipient

serum Dnr r'd 7'&

>

> >

> >

No (ell boun$ antibo$+

a##lutination

'MPATI&!E

>

>>

>

>

>

Antibo$+ bin$s to (ells

No a##lutination

IN'MPATI&!E


14/33

TRANSFUSI KOMPONEN SEL

• K'untun*an %

!. Tida, m'nam-ah &um' darah

2. P'nd'rita han+a m'nda(at ,m(n'n+an* di-utuh,an

. Gan**uan imun&*i da(at di,uran*i

;. M'mudah,an tran#$u#i 5da(at m'n&n*! ('nd'rita +an* m'm-utuh,an6


15/33

Ma7am tran$u#i ,m(n'n

!. S'&&u&'r

a. Eritr#it

-. L'u,#it7. Trm-#it

2. Nn #'&u&'r

d. P&a#ma'. Fra,#i (&a#ma


16/33


17/33

&loo$ 'omponents an$ Plasma Deri,ati,es )-*

'omponent.Pro$u(t 'omposition /olume In$i(ations

0%ole &loo$ R&'s )appro12 H(t 345*6 plasma6 744 ml In(rease bot% (ell mass 8 plasma

0&'s6 platelets ,olume )0&'s 8 platelets notfun(tional6 plasma $efi(ient in labile

(lottin# Fa(tors / an$ /III*

Re$ &loo$ 'ellsR&' )appro12 H(t 975*6 re$u(e$ :74 ml In(rease re$ (ell mass in s+mptom

plasma; 0&'s; an$ platelets ati( anemia )0&'s 8 platelets not

fun(tional*

R'd B&d 1'& RB1 5a((r. "7t :6H r'du7'd m& In7r'a#' r'd 7'&& ma## in #+m(tmati7 Ad'nin'Sa&in' (&a#ma0 WB1#0 and (&at'&'t#H an'mia 5WB1# and (&at'&'t# nt

Add'd ! m& $ additi' #&utin $un7tina&6

R&'s !euko(+tes < =75 ori#inal ,olume of R&'6 ::7 ml In(rease$ re$ (ell mass6 > 7 1 -4? 0&'sRe$u(e$ )prepa@ > 7 1 -4? 0&'6 fe platelets6 to $e(rease t%e likeli%oo$ of febrile rea(@

re$ b+ filtration*minimal plasma tions; immuniBation to leuko(+tes )H!A*

anti#ens* of 'M/ transmission

R&'s 0as%e$ R&'s )appro1; H(t 975*6 -=4 ml In(rease re$ (ell mass6 re$u(e$ risk of

> 7 1 -4= 0&'s6 no plasma aller#i( rea(tions to plasma proteins

RB1# Fr'nH RB1 5a((r. "7t =


18/33

&loo$ 'omponents an$ Plasma Deri,ati,es ):*


Garnu&7+t'# Granu&7+t'# 5!. !! 22 m& Prid' *ranu&7+t'# $r #'&'7t'd (ati'nt#

Ph'r'#i# PMN/unit6H &+m(h7+t'#H 4ith #'(#i# and #''r' n'utr('nia(&at'&'t# 52. !!!/unit6H 5J


19/33

&loo$ 'omponents an$ Plasma Deri,ati,es )III*


Fa(tor /III Fa(tor /III6 tra(e amount of ot%er :7 ml Hemop%ilia A )Fa(tor /III $efi(ien(+*6

)(onsentraes6 plasma proteins )pro$u(ts ,ar+ 0illebran$s $isease )off@label use for Re(ombinant %uman in purit+* sele(te$ pro$u(ts onl+*

Fa(tor /III*

Fa(tor I )(on(en@ Fa(tor I6 tra(e amount of ot%er :7 ml Hemop%ilia & )Fa(tor I $efi(ien(+*

Trates; re(ombi plasma proteins )pro$u(ts ,ar+

Nant %uman in purit+*

Fa(tor I*

Albumin.PPF Albumin; some @; @#lobulins )75*6 /olume e1pansion

):75*

Immune "lobulin I#" antibo$ies preparations for ,aries Treatment of %+po@or a#amma#lobuline

I/ an$ . or IM use mia6 $isease prop%+la1is6 autoimune

t%rombo(+topenia )I/ onl+*

R% Immune I#" anti@D6 preparations for I/ - ml Pre,ention of %emol+ti( $isease of t%e

"lobulin an$.or IM use neborn $ue to D anti#en6 treatment of

autoimmune t%rombo(+topenia

Antit%rombin Antit%rombin6 tra(e amount of -4 ml Treatment of antit%rombin $efi(ien(+

ot%er plasma proteins

RB1# r'd -&d 7'&H "7t h'mat7ritH WB1# 4hit' -&d 7'&H 1M 7+tm'*a&iru#H PMN (&+mr(hnu7&'ar 7'&HFFP $r'#h $r'n (&a#maH PPF (&a#ma (rt'in $ra7tinH I intra'nu#H IM intramu#7u&ar


20/33

In$ikasi Pen##antian faktor G faktor Hemostatik pa$a Pasien Trauma

-

T'ntu,an #tatu# ,a*u&a#i (a#i'n0 -i&a mun*,in d'n*ant'# &a-ratrium +an* t'(at

- P'dman ,&ini# %

&ua# dan &,a#i ('r&u,aan

&ama r'n)atan -'r&an*#un*

r'#(n t'rhada( r'#u#ita#i a4a& ri#i, ,m(&i,a#i0 mi#a&n+a ('rdarahan intra,ania&

- Ganti ,m(n'n darah untu, m'm('r-ai,i ,'&ianan #('#i$i,

- P'dman untu, ,m(n'n darah #('#i$i, % B'ri,an tran#$u#i

trm-#it % -i&a )um&ah trm-#it J C @ ! !9/L

FFP % -i&a ma#a (rtrm-in /

ma#a trm-(&a#tin (ar#ia& !0< nrma&

Kri(r'#i(itat % -i&a ,adar $i-rin*'n J ! */L


21/33

TRANSFUSI TRM&SIT

• Trm-#it di#im(an da&am ,ndi#i di*+an*

t'ru# 5Reciprocal agitator 60 #uhu ,amar

5216

• "aru# #'*'ra di-'ri,an 5tida, -&'h

di#im(an di ,u&,a#/di ruan*an6

• K'7'(atan 7'(at

• Guna,an in$u# #'t ,hu#u# Platelet

Administration Set = TERUUSS!"#

5T'rum6Q


22/33

KE&UTUHAN TRM&SIT

• Trm-#it%- d#i# umumn+a% ! unit ('r ! ,* BB

5


23/33

'orre(te$ platelet in(rement )'I*

)P- G P4* 1 &SA 1 n@-

P- platelet (ount before transfusion )-4 .l*

P4 platelet (ount - %our after transfusion )-4

.l*&SA re(ipients bo$+ surfa(e area; m:

N number of units of platelet (on(entrates transfuse$;

ea(% < 4;77 1 -4--

A (orre(te$ platelet in(rement - %our after a$ministrationt%at is %i#%er t%an 9;7 1 -4 .l in$i(ates a su((essful

transfusion of platelets


24/33

KE&UTUHAN P!ASMA.FFP

• D#i# t'r*antun* ,ndi#i ,&ini# dan ('n+a,itda#ar

• Coagulation %actor replacement %

! @ 2 m&/,* BB 5 ;: unit (d d'4a#a6• D#i# ini dihara(,an da(at m'nin*,at,an

$a,tr ,a*u&a#i 2 #'*'ra #'t'&ah tran#$u#i

•

P&a#ma +an* di7air,an 5#uhu = 16 haru##'*'ra ditran#$u#i,an

• ABORh t+(in* #a)a 5ta, ('r&u 7r## mat7h6


25/33

'RJPRE'IPITATE

C!2 unit Fa7tr III % 1 5(r7a*u&ant

a7tiit+6 2


26/33

KE&UTUHAN KRIPRESIPITAT

B'ri#i %

C!2 unit Fa7tr III % 1 5 procoagulantacti&it' 6

2


27/33

PEM&ERIAN TRANSFUSI DARAH

pa$a PASIEN

• Nilai ulan#

@ (%e(k list pelaksanaan transfusi $ara%

@ #olon#an $ara% pasien $onor L )tan+akan*

@ i$entitas pasien tepat L

@ i$entitas $onor $an #ol $r% $onor

label mera% mu$a; puti%; biru mu$a;

kunin#

@ aasi selama $an setela% transfusi

)tan##un# jaab $okter*

@ aasi reaksi transfusi $ara%


28/33

R'a,#i tran#$u#i

Suatu r'a,#i '$', #am(in* +an* -'r,aitand'n*an tran#$u#i dan ,m(n'n darah

K')adian +an* tida, m'n*an7am #am(ai

$ata& "'m&iti,/nnh'm&iti,0 da(at m'n+'-a-,an

d'#tru,#i 'ritr#it A,ut % n#'t 7'(at

Lam-at % hari #am(ai min**uan M'&i-at,an int'ra,#i A*A-0 ('n+'-a-

in$',#i


29/33

A(ute Transfusion Rea(tions )-*

T+pe Si#n an$ S+mptoms Usual 'ause Treatment Pre,ention

Intra,as(ular Hemo#lobinemia an$ A& in(ompatibilit+ Stop transfusion6 A,oi$ (leri(al

%emol+ti( %emo#lobinuria; fe,er; )(leri(al error* or ot%er %+$rate; support errors6 ensure)immune* (%ills; an1iet+; s%o(k; DI'; (omplement G fi1in# bloo$ pressure 8 proper sample

$+spnea; (%est pain; antibo$+ (ausin# respiration6 in$u(e 8 re(ipient

flank pain; oli#uria anti#en G antibo$+ $iuresis6 treat s%o(k

i$entifi(ation in(ompatibilit+ an$ DI'; if present

E1tra,as(ular Fe,er; malaise; in$ire(t I#" Monitor Ht; A,oi$ (leri(al

Hemol+ti( %iperbilirubinemia; non@(omplement@ renal 8 %epati( error ensure)immune* in(rease$ urine urobili@ fi1in# antibo$+ often fun(tion; (oa#ulati proper sample

no#en; fallin# %emato(rit asso(late$ it% on profile; no a(ute 8 re(ipient

$ela+e$ %emol+sis treatment #enerall+ i$entifi(ation

reuire$

Febrile Fe,er; (%ill; rarel+ Antibo$ies to Stop transfusion6 Pre transfusion

%+potension leuko(+tes or plasma #i,e antip+reti(6 antip+reti(6

protein6 %emol+sis6 e#; a(etaminop%en leuko(+te@passi,e (+tokines 6 for ri#ors re$u(e$ bloo$

infusion6 sepsis2 Use meperi$ine :7@ if re(urrent

'ommonl+ $ue to 74 m# I/ or IM

patients un$erl+in#

(on$ition

(continued)


30/33

Table 72 A(ute Transfusion Rea(tions ):*


Aller#i( )mil$ Urti(aria )%i,es*; rarel+ Antibo$ies to plasma Stop transfusion6 Pre@transfusion

To se,ere* %+potension or anap%+@ proteins6 rarel+ anti@ #i,e6 anti%istamine anti%itamine6la1is bo$ies to I#A )P or IM*6 if se,ere; as%e$ R&'

epinep%rine an$.or (omponents; if

steroi$s re(urrent or

se,ere (%e(k

pre@

transfusion I#A

le,els in patientsit% a %istor+ of

of anap%+la1is

to transfusion

H+per,olemi( D+spnea; %+pertension Too rapi$ an$.or In$u(e$ $iuresis6 A,oi$ rapi$ or

pulmonar+ e$ema; e1(essi,e bloo$ p%lebotom+6 e1(essi,e

(ar$ia( arr%+tmias transfusion support (ar$io@ transfusionrespirator+ s+stem

as nee$e$

(continued)

A t T f i R ti )C*


31/33

A(ute Transfusion Rea(tions )C*


Transfusion@ D+spnea; fe,er H!A or leuko(+te Support bloo$ !euko(+te@re$u(e$

relate$ a(ute pulmonar+ e$ema; antibo$ies6 usuall+ pressure an$ R&'s if re(ipientlun# injuri %+potension; normal $onor antibo$+ respiration )ma+ %as t%e antibo$+6

)TRA!I* pulmonar+ (apillar+ transfuse$ it% reuire intubation* notif+ transfusion

e$#e pressure plasma in (ompo ser,i(e to uaran@

nents tine remainin#

(omponents from

$onor

&a(terial Ri#ors; (%ills; fe,er; 'ontaminate$ Stop transfusion6 'are in bloo$

sepsis s%o(k bloo$ (omponent support bloo$ (olle(tion an$

pressure6 (ulture stora#e6 (areful

patient an$ bloo$ attention to arm@

unit6 #i,e antibioti(s preparation for

6 notif+ bloo$ trans@ p%lebotom+

fusion ser,i(e

DI1 di##'minat'd intraa#7u&ar 7a*u&atinH I intra'nu#H IM intramu#7u&arH PO -+ muthHRB1 r'd -&d 7'&


32/33

0orkup of an A(ute Transfusion Rea(tion

If an a(ute transfusion rea(tion o((urs

!. St( -&d 7m(n'nt tran#$u#in imm'diat'&+

2. 'ri$+ th' 7rr'7t unit 4a# *i'n t th' 7rr'7t (ati'nt

. Maintain I a77'## and 'n#ur' ad'uat' urin' ut(ut 4ith an a((r(riat' 7r+#ta&&id r 7&&id #&utin;. Maintain -&d (r'##ur'0 (u'

r, % 1hru7hi&& Liin*#tn'0 !99< H 2;


33/33

TERIMA KASI"

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