Post on 07-Jul-2018
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TRANSFUSI DARAH
M.I. Diah Pramudianti
BAGIAN/SMF PATOLOGI KLINIK
RSUD DR MOEWARDI/FK UNS
SURAKARTA
2!2
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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
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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, $a,tr
('m-',uan
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TRANSFUSI DARA"
• Prdu, darah +an* di-'ri,an %
A.Whole blood % -'ri#i #'mua ,m(n'n
darah &'n*,a(
B.Km(n'n darah % #udah m'n*a&ami('mi#ahan untu, m'm('r&'h ,m(n'n
darah +an* di-utuh,an.
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"EMAFERESIS
• Pr#'dur ('n*am-i&an darah dari
#'#'ran* dimana ,m(n'n darah +an*
di('r&u,an diam-i& dan +an* tida,
di('r&u,an dima#u,,an ,'m-a&i ,' ran*
t'r#'-ut.
A. Sit$'r'#i# % 'ritr#it$'r'#i#0
&'u,#it$'r'#i#0 trm-#it$'r'#i#
B. P&a#ma$'r'#i#
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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
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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
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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,
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"olon#an $ara% A&
F'nti(
O
A!
A2
B
A!B
A2B
G'nti(
OO
A! A!
A!O A! A2
A2 A2 A2O
BB
BO
A!B
A2B
Anti*'n
'ritr#it
"
A A!
A "
B 5"6
A A! B
A B 5"6
Anti-di
#'rum
AntiA
AntiB
AntiB
AntiB
5Anti A!6
AntiA
tida, ada
5Anti A!
6
Fr',u'n#i
Kau,a#ia Ori'nta&
;<
;: C
;= 22
!
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!
”Transfusion rules for RBC “di dalam sistem ABO
Pada transfusi RBC, antara eritrosit donor & plasma resipien
harus terdapat compatibilitas ABO & Rh1.Grup O hanya dapat menerima darah dr donor grup O
.Grup A hanya dapat menerima darah dr donor grup A & O
!.Grup B hanya dapat menerima darah dr donor grup B & O
".Grup AB dapat menerima darah dr donor grup AB, A, Bdan O
O # donor uni$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
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“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
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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.
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'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$s to (ells
No a##lutination
IN'MPATI&!E
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TRANSFUSI KOMPONEN SEL
• K'untun*an %
!. Tida, m'nam-ah &um' darah
2. P'nd'rita han+a m'nda(at ,m(n'n+an* di-utuh,an
. Gan**uan imun&*i da(at di,uran*i
;. M'mudah,an tran#$u#i 5da(at m'n&n*! ('nd'rita +an* m'm-utuh,an6
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Ma7am tran$u#i ,m(n'n
!. S'&&u&'r
a. Eritr#it
-. L'u,#it7. Trm-#it
2. Nn #'&u&'r
d. P&a#ma'. Fra,#i (&a#ma
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&loo$ '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 =
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&loo$ 'omponents an$ Plasma Deri,ati,es ):*
'omponent.Pro$u(t 'omposition /olume In$i(ations
Garnu&7+t'# Granu&7+t'# 5!. !! 22 m& Prid' *ranu&7+t'# $r #'&'7t'd (ati'nt#
Ph'r'#i# PMN/unit6H &+m(h7+t'#H 4ith #'(#i# and #''r' n'utr('nia(&at'&'t# 52. !!!/unit6H 5J
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&loo$ 'omponents an$ Plasma Deri,ati,es )III*
'omponent.Pro$u(t 'omposition /olume In$i(ations
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 $ra7tinH I intra'nu#H IM intramu#7u&ar
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In$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 $i-rin*'n J ! */L
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TRANSFUSI TRM&SIT
• Trm-#it di#im(an da&am ,ndi#i di*+an*
t'ru# 5Reciprocal agitator 60 #uhu ,amar
5216
• "aru# #'*'ra di-'ri,an 5tida, -&'h
di#im(an di ,u&,a#/di ruan*an6
• K'7'(atan 7'(at
• Guna,an in$u# #'t ,hu#u# Platelet
Administration Set = TERUUSS!"#
5T'rum6Q
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KE&UTUHAN TRM&SIT
• Trm-#it%- d#i# umumn+a% ! unit ('r ! ,* BB
5
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'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
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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#$u#i,an
• ABORh t+(in* #a)a 5ta, ('r&u 7r## mat7h6
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'RJPRE'IPITATE
C!2 unit Fa7tr III % 1 5(r7a*u&ant
a7tiit+6 2
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KE&UTUHAN KRIPRESIPITAT
B'ri#i %
C!2 unit Fa7tr III % 1 5 procoagulantacti&it' 6
2
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PEM&ERIAN TRANSFUSI DARAH
pa$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 $ara%
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R'a,#i tran#$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
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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$ition
(continued)
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Table 72 A(ute Transfusion Rea(tions ):*
T+pe Si#n an$ S+mptoms Usual 'ause Treatment Pre,ention
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*
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A(ute Transfusion Rea(tions )C*
T+pe Si#n an$ S+mptoms Usual 'ause Treatment Pre,ention
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'&
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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;
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TERIMA KASI"